Teaching materials in electronic format for medical education in the subject of Surgical Proceedings in the degree of Medicine

La Cirugía es la parte de la Medicina que tiene por objeto curar las enfermedades por medio de operaciones hechas con las manos o a través de instrumentos. Hasta ahora, la enseñanza de la asignatura de “Procedimientos Quirúrgicos”, que corresponde a los estudiantes de segundo curso del Grado en Medicina de la Universidad de Córdoba, se ha llevado a cabo según el estilo tradicional. Se ha llevado a cabo un proyecto específico de elaboración de una herramienta multimedia, en concreto, un ebook, con el contenido teórico y práctico de la asignatura de Procedimientos Quirúrgicos, para mejorar la docencia médica según las directrices del Espacio Europeo de Educación Superior (EEES), fomentando así el desarrollo de una educación médica de calidad.Surgery is the branch of Medicine concerned with diseases and conditions requiring or amenable to operative or manual procedures. To date, teaching the subject of Surgical Procedures for 2nd-year students of the degree of Medicine has been done in a traditional manner. We have developed a specific project, with the creation of a multimedia resource consisting in an ebook with the theoretical and practical content of the Surgical Proceedings subject, in order to improve medical learning following the principles of the European Higher Education Area. This will aid in promoting the development of a high-quality medical teaching

Intraoperative metabolic changes associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) causes considerable hemodynamic, respiratory, and metabolic changes during the perioperative period. Objectives: To evaluate metabolic changes associated with this procedure. Understanding perioperative factors and their association with morbidity may improve the perioperative management of patients undergoing this treatment. Methods: A retrospective review of a prospectively maintained database was performed. All consecutive unselected patients who underwent CRS plus HIPEC between January 2018 and December 2020 (n = 219) were included. Results: The mean age was 58 ± 11.7 years and 167 (76.3%) were female. The most frequent histology diagnosis was serous ovarian carcinoma 49.3% (n = 108) and colon carcinoma 36.1% (n = 79). Mean peritoneal cancer index was 14.07 ± 10.47. There were significant variations in pH, lactic acid, sodium, potassium, glycemia, bicarbonate, excess bases, and temperature (p < 0.05) between the pre-HIPEC and post-HIPEC periods. The closed HIPEC technique resulted in higher levels of temperature than the open technique (p < 0.05). Age, potassium level post-HIPEC potassium level, and pre-HIPEC glycemia were identified as prognostic factors for morbidity in multivariate analysis. Conclusion: The administration of HIPEC after CRS causes significant changes in internal homeostasis. Although the closed technique causes a greater increase in temperature, it is not related to higher morbidity rates. The patient’s age, post-HIPEC potassium level, and pre-HIPEC glycemia are predictive factors for morbidity

Intraoperative oxygen tension and redox homeostasis in Pseudomyxoma peritonei: A short case series

IntroductionPseudomyxoma peritonei (PMP) is a rare malignant disease characterized by a massive multifocal accumulation of mucin within the peritoneal cavity. The current treatment option is based on complete cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. However, the recurrence is frequent with subsequent progression and death. To date, most of the studies published in PMP are related to histological and genomic analyses. Thus, the need for further studies unveiling the underlying PMP molecular mechanisms is urgent. In this regard, hypoxia and oxidative stress have been extensively related to tumoral pathologies, although their contribution to PMP has not been elucidated.MethodsIn this manuscript, we have evaluated, for the first time, the intratumoral real-time oxygen microtension (pO2mt) in the tumor (soft and hard mucin) and surrounding healthy tissue from five PMP patients during surgery. In addition, we measured hypoxia (Hypoxia Inducible Factor-1a; HIF-1α) and oxidative stress (catalase; CAT) markers in soft and hard mucin from the same five PMP patient samples and in five control samples.ResultsThe results showed low intratumoral oxygen levels, which were associated with increased HIF-1α protein levels, suggesting the presence of a hypoxic environment in these tumors. We also found a significant reduction in CAT activity levels in soft and hard mucin compared with healthy tissue samples.DiscussionIn conclusion, our study provides the first evidence of low intratumoral oxygen levels in PMP patients associated with hypoxia and oxidative stress markers. However, further investigation is required to understand the potential role of oxidative stress in PMP in order to find new therapeutic strategies

Survival of patients receiving a liver transplant for hepatocellular carcinoma, and risk of tumor recurrence

Objective: the goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of posttransplant tumor relapse and factors related to this complication. Design: retrospective study of a consecutive series of patients having had liver transplant for HCC. Patients and methodology: transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis. Results: the survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR = 1,7944) (IC 95% = 1,1332-2,8413) and the vascular invasion (OR = 6,6346) (IC 95% = 1,4624-30,1003) as risk factors of relapse. Conclusions: the liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion

MATERIAL DOCENTE EN FORMATO ELECTRÓNICO PARA LA ENSEÑANZA DE LA ASIGNATURA DE PROCEDIMIENTOS QUIRÚRJICOS EN EL GRADO DE MEDICINA

Surgery is the branch of Medicine concerned with diseases and conditions requiring or amenable to operative or manual procedures. To date, teaching the subject of Surgical Procedures for 2nd-year students of the degree of Medicine has been done in a traditional manner. We have developed a specific project, with the creation of a multimedia resource consisting in an ebook with the theoretical and practical content of the Surgical Proceedings subject, in order to improve medical learning following the principles of the European Higher Education Area. This will aid in promoting the development of a high-quality medical teaching.La Cirugía es la parte de la Medicina que tiene por objeto curar las enfermedades por medio de operaciones hechas con las manos o a través de instrumentos. Hasta ahora, la enseñanza de la asignatura de “Procedimientos Quirúrgicos”, que corresponde a los estudiantes de segundo curso del Grado en Medicina de la Universidad de Córdoba, se ha llevado a cabo según el estilo tradicional. Se ha llevado a cabo un proyecto específico de elaboración de una herramienta multimedia, en concreto, un ebook, con el contenido teórico y práctico de la asignatura de Procedimientos Quirúrgicos, para mejorar la docencia médica según las directrices del Espacio Europeo de Educación Superior (EEES), fomentando así el desarrollo de una educación médica de calidad

Superior mesenteric artery syndrome in a patient with Charcot Marie Tooth disease

The extrinsic compression of the third part of the duodenum as it passes through the aorto-mesenteric angle is known as the superior mesenteric artery syndrome (SMAS). This syndrome is a rare mechanical cause of upper intestinal obstruction, with a reported incidence of between 0.2% and 0.78%. Clinical manifestations of SMAS may be chronic or acute; chronic symptoms include intermittent gastric pain, fullness and occasional episodes of postprandial vomiting, while acute symptoms include incoercible vomiting, oral intolerance, mainly epigastric abdominal distension and abdominal pain. Surgery is recommended only when initial conservative treatment fails. Here, we report what appears to be the third published case of SMAS associated with hereditary motor and sensory neuropathy or Charcot Marie Tooth disease

Colorectal peritoneal metastases: Optimal management review.

The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies