Comparison of leucine-rich alpha-2-glycoprotein-1 (LRG-1) plasma levels between patients with and without appendicitis, a case–controlled study

Acute appendicitis (AA) is the frst cause of emergency surgery. Leucine-Rich Alpha-2-Glycoprotein 1 (LRG1) has been shown to be a potential biomarker in cases of AA in children, but there are conficting results for its use in adults. The objective of this study is to compare the median plasma values of LRG1 in patients with acute abdomen with and without appendicitis. This case–control study was conducted prospectively at the emergency room (ER) of a tertiary teaching hospital, between March 1st, 2011 and December 31st, 2012. Patients with recent abdominal pain, aged 18–70 years who attended at the ER were included in the study. Blood samples were drawn at the frst presentation. Those who were submitted to surgery and had a pathology report of AA were considered as cases. Those without a need for surgery and treated for other conditions, e.g., pelvic infammatory disease, were considered as controls. Follow-up in controls was made up to 30 days. LRG1 plasma median values were measured using an ELISA kit and compared between groups. A total of 28 participants, 14 cases with acute appendicitis and 14 controls, were included. The median (range) values of leucine-rich alpha-2-glycoprotein-1 level in the group with appendicitis and control group were 8.8 ng/ml (5.5–31) and 11 (4.6–108) ng/ml, respectively (Mann–Whitney test P= 0.26). Median plasma leucine-rich alpha-2-glycoprotein-1 levels were not useful in diagnosing Acute Appendicitis in patients with acute abdominal pain

Comparison of the internal thoracic artery flow dissected by video endoscopy or conventional technique

Purpose: To compare the blood flow in the internal thoracic artery when dissected endoscopically in a conventional manner, in addition to develop a reliable experimental training model for the surgical team. Methods: Paired experimental study. Ten pigs were operated and had both internal thoracic arteries dissected, the right with a conventional technique and the left by video endoscopy. The main outcomes to be studied were flow, length, and time of dissection of each vessel. Results: Blood flow measurements were performed with mean heart rate of 100 ± 16 bpm and mean arterial pressure of 89.7 ± 13 mm Hg. The mean blood flow of endoscopic dissection of the internal thoracic artery was 170.2 ± 66.3 mL/min and by direct view was 180.8 ± 70.5 (p = 0.26). Thus, there was no statistically significant difference between the flows, showing no inferiority between the methods. Conclusions: The minimally invasive dissection of the internal thoracic artery was shown to be not inferior to the dissection by open technique in relation to the blood flow in the present experimental model. In addition, the model that we replicated was shown to be adequate for the development of the learning curve and improvement of the endoscopic abilities

A realidade virtual pode ser tão boa como o treinamento em sala cirúrgica? : experiências de um programa de residência em cirurgia geral

Background: The increasingly intense usage of technology applied to videosurgery and the advent of robotic platforms accelerated the use of virtual models in training surgical skills. Aim: To evaluate the performance of a general surgery department’s residents in a videosimulated laparoscopic cholecystectomy in order to understand whether training with virtual reality is sufficient to provide the skills that are normally acquired in hands-on experience at the operating room. Methods: An observational study with twenty-five first- and second-year general surgery residents. Each subject performed three video-laparoscopic cholecystectomies under supervision in a simulator. Only the best performance was evaluated in the study. Total number of complications and total procedure time were evaluated independently. The groups were defined according to total practice time (G1 and G2) and the year of residency (R1 and R2), each being analysed separately. Results: Twenty-one residents finished the three practices, with four follow-up losses. Mean practice time was 33.5 hours. Lowering of the rate of lesions in important structures could be identified after a level of proficiency of 60%, which all participants obtained regardless of previous in vivo experience. No significant difference between the R1 and R2 groups was observed. Conclusion: Learning in groups R1 and R2 was equal, regardless of whether previous practice was predominantly in vivo (R2) or with virtual reality (R1). Therefore, it is possible to consider that skills obtained in virtual reality training are capable of equalising the proficiency of first- and second-year residents, being invaluable to increase patient safety and homogenise learning of basic surgical procedures.Racional: O uso cada vez mais intenso da tecnologia aplicado à cirurgia em vídeo e o advento das plataformas robóticas, aceleraram o uso de modelos virtuais no treinamento de habilidades cirúrgicas. Objetivo: Avaliar o desempenho dos médicos residentes em um serviço de cirurgia geral em colecistectomia vídeo simulada laparoscópica em um centro de realidade virtual para entender se o treinamento de realidade virtual é suficiente para equipará-lo às habilidades adquiridas no centro cirúrgico. Método: Estudo observacional transversal com 25 residentes de cirurgia geral do primeiro e segundo anos. Cada residente realizou três colecistectomias videolaparoscópicas com supervisão em um simulador. O melhor desempenho foi avaliado no estudo. O número total de complicações e tempo total do procedimento foram avaliados de forma independente. Os grupos foram definidos de acordo com o tempo total de prática (G1 e G2) e o ano de residência (R1 e R2), os quais foram analisados isoladamente. Resultados: Vinte e um médicos residentes médicos concluíram as 3 práticas, com 4 perdas de seguimento e praticaram uma média de 33,5 h. Diminuição das lesões em estruturas importantes foi identificada após nível de proficiência de 60%, que todos os participantes obtiveram independentemente da experiência anterior in vivo. Não houve diferença significativa entre os resultados dos grupos R1 e R2. Conclusões: O aprendizado dos grupos R1 e R2 pode ser considerado igual, independentemente de a prática anterior ser majoritariamente in vivo (R2) ou em realidade virtual (R1). Assim, é possível considerar que as habilidades cirúrgicas adquiridas a partir do treinamento virtual são capazes de equiparar a proficiência dos residentes de primeiro e segundo ano, sendo fundamental para aumentar a segurança dos pacientes e homogeneizar o aprendizado de procedimentos cirúrgicos básicos

Current status of residency training in laparoscopic surgery in Brazil : a critical review

Introdução: A formação do cirurgião geral vem se modificando nas últimas décadas. O aumento das escolas médicas, as novas especialidades e as modernas tecnologias induzem à reformulação do ensino médico. A residência médica em cirurgia estabeleceu-se como etapa fundamental na formação do cirurgião e surge como a forma ideal e natural para o ensino da videocirurgia. No entanto, a introdução da videocirurgia nos programas de residência médica nas diversas especialidades cirúrgicas é insuficiente, gerando a necessidade de treinamento complementar após o seu término. Objetivo: Rever a situação de ensino da videocirurgia em serviços que publicaram seus métodos. Método: Revisão de conteúdo publicado em livros e na internet considerados relevantes, além de pesquisa nas bases de dados PubMed, Lilacs e Scielo até julho 2014 com os descritores: videocirurgia; simulação; educação médica; aprendizagem; treinamento em cirurgia. Resultado: O método de treinamento em programas de residência médica em cirurgia, focado na realização de procedimentos cirúrgicos sob supervisão em pacientes, comprovou sua eficiência na era da cirurgia aberta. No entanto, configura conceitualmente um processo de experimentação em seres humanos. O aprendizado psicomotor não deve e não pode ser desenvolvido diretamente no paciente A formação em videocirurgia requer a aquisição de habilidades psicomotoras únicas, através de treinamento realizado inicialmente por simulação cirúrgica. Plataformas de ensino baseadas na solução de problemas como o Fundamentals of Laparoscopic Surgery, desenvolvido pela Sociedade Americana de Cirurgia Endoscópica Gastrointestinal e o Laparoscopic Surgical Skills proposto pela Sociedade Europeia de Cirurgia Endoscópica são exemplos que têm sido amplamente utilizados tanto para o ensino como para a acreditação de cirurgiões em todo o mundo. Conclusão: É necessário o estabelecimento de um processo pedagógico mais adequado para o ensino da videocirurgia nas residências médicas no sentido de conferir base educacional sólida, determinando atividade profissional bem estruturada e segura.The surgeon’s formation process has changed in recent decades. The increase in medical schools, new specialties and modern technologies induce an overhaul of medical education. Medical residency in surgery has established itself as a key step in the formation of the surgeon, and represents the ideal and natural way for teaching laparoscopy. However, the introduction of laparoscopic surgery in the medical residency programs in surgical specialties is insufficient, creating the need for additional training after its termination. Objective: To review the surgical teaching ways used in services that published their results. Methods: Survey of relevant publications in books, internet and databases in PubMed, Lilacs and Scielo through july 2014 using the headings: laparoscopy; simulation; education, medical; learning; internship and residency. Results: The training method for medical residency in surgery focused on surgical procedures in patients under supervision, has proven successful in the era of open surgery. However, conceptually turns as a process of experimentation in humans. Psychomotor learning must not be developed directly to the patient Training in laparoscopic surgery requires the acquisition of psychomotor skills through training conducted initially with surgical simulation. Platforms based teaching problem solving as the Fundamentals of Laparoscopic Surgery, developed by the American Society of Gastrointestinal Endoscopic Surgery and the Laparoscopic Surgical Skills proposed by the European Society of Endoscopic Surgery has been widely used both for education and for the accreditation of surgeons worldwide. Conclusion: The establishment of a more appropriate pedagogical process for teaching laparoscopic surgery in the medical residency programs is mandatory in order to give a solid surgical education and to determine a structured and safe professional activity

Critical Theory and Intellectual History in José Sazbón

La intervención teórico-política de José Sazbón (1937-2008) puede ser entendida como un esfuerzo por articular historia intelectual y teoría crítica. Por un lado, nos ofrece una historia intelectual de la teoría crítica que busca hacer patente para la propia teoría crítica las condiciones históricas de sus posibilidades y dificultades. Por otro lado, plantea una teoría crítica de la historiografía que exige a esta última una orientación política normativa en la que anclar el sentido a su labor. En su sistemática articulación, ambas orientaciones confluyen en la formulación de un amplio programa, aún vigente, de historia crítica del marxismo occidental.The theoretical-political intervention of José Sazbón (1937-2008) can be understood as an effort to connect intellectual history and critical theory. On one hand, it offers an intellectual history of critical theory that seeks to make obvious the historical conditions of its possibilities and difficulties. On the other hand, it proposes a critical theory of historiography that demands from the latter a normative political orientation in which the meaning of its labor is anchored. In their systematic correlation, both orientations flow together to formulate a broad and still timely program of critical history for Western Marxism.Fil: Garcia Garcia, Luis Ignacio. Universidad Nacional de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Gallbladder protrusion through the groin region : a very unusual femoral hernia

Groin hernias are among the oldest recorded afflictions of mankind. Most of them protrude through the inguinal canal, and only a few through the femoral canal. Usually, they are present as a painful lump in the groin region, and their complications arise if they become incarcerated or strangulated. Incarcerated hernias may contain a variety of contents, such as the omentum, small bowel, colon, bladder, appendix, stomach, or ovary as previously described. Usually, the history and a physical examination are sufficient to make the diagnosis. However, the wide use of CT has become an effective instrument to identify the contents of hernias and has helped surgeons program the best management. This article reports, for the first time, the case of an 81-year-old female with an incarcerated femoral hernia that contains the gallbladder

Complex ventral hernia repair in a child : an association of botulinumtoxin, progressive pneumoperitoneum and negative pressure therapy : a case report on an arising surgical technique

INTRODUCTION: The purpose of this manuscript is to report the management of a child born with giantomphalocele (GO) that developed a complex ventral hernia secondary to an unsuccessful attempt ofclosing the primary defect. PRESENTATION OF CASE: The patient underwent a one-step surgery to correct a ventral hernia associatedwith a largely prolapsed enteroatmospheric fistula (EAF) along with an ileostomy. It was managed bya pre-operative association of botulinum toxin agent (BTA) application with preoperative progressivepneumoperitoneum (PPP) and trans-operative negative pressure wound therapy (NPWT) dressing withstaged abdominal closure. The patient needed 4 reoperations due to enteric fistulas. Nine days after thefirst surgery, it was possible to completely close the abdominal wall without mesh substitution. No signsof hernia in 9 months of follow-up. DISCUSSION: This is the second report in the literature and it reinforces the safety and effectiveness ofthe BTA injection associated with PPP in children. CONCLUSION: The use of BTA in association with PPP should be encouraged and best investigated inpatients with GO. The fistulas were not attributed to the negative pressure. Maybe it is time to startdefining better criteria to categorize GO in order to choose the best management for each patient