ABSTRACT
El año 2008, los Departamentos de Medicina, Obstetricia, Ginecología y Pediatría y Cirugía Infantil, del Campus Occidente de la Facultad de Medicina de la Universidad de Chile, iniciaron un programa de 6 años para formar Especialistas para la Atención Primaria. PROPÓSITO: Relatar la experiencia, a 12 meses de iniciada. El Programa alterna rotaciones de 6 meses en la Facultad y en el sitio original de trabajo en atención primaria y surgió de un acuerdo con el Ministerio de Salud. En la Facultad la idea fue acogida con interés, pero no sin reservas. El artículo relata las reservas iniciales, con su evolución respectiva, y muestra la forma en que se ha desarrollado la experiencia durante su primer año. MATERIAL Y MÉTODO: Se presentan las opiniones del grupo de académicos ejecutores directos en el Campus Occidente. RESULTADOS: Se diseñó un programa de igual exigencia que el programa tradicionales de tres años pero de doble duración para dejar espacio a las rotaciones por Atención Primaria. Esto ha obligado a implementar muchas medidas (sistema de registro riguroso de experiencias, calificaciones, decisiones, permisos, etc.; reuniones de seguimiento y evaluación de las partes involucradas), recurrir a la creatividad de los académicos y flexibilizar la metodología del programa tradicional, de tres años. CONCLUSIONES: Hasta el momento, la experiencia es altamente satisfactoria y estimulante para la Facultad. No se ha sufrido dificultades mayores y los alumnos están satisfechos. Entre algunas de las múltiples ventajas adicionales que parece mostrar este programa, estos becados han servido de nexo entre sus consultorios de base y nuestros servicios hospitalarios, con los consecuentes beneficios para la población beneficiaria, lo que representa una fortaleza no menor porque lograría dar consistencia a la red de salud. Naturalmente, se mantendrá vigilancia sobre los aspectos...
In 2008 the three Departments of Medicine, Obstetrics and Gynecology and Pediatrics and Infantile Surgery of the Western Campus of the University of Chile began a new 6 years program to train specialist physicians for Primary Care in Internal Medicine, Obstetrics and Gynecology and Pediatrics. The Program alternates 6 months shifts at the Faculty and at original working places in primary care and emerged after an agreement between the Faculty and the Ministry of Health. AIM: To document the first 12 months of this experience. At a Faculty the idea was welcomed with a combination of interest and doubts. This article documents the evolution of these doubts and the way the experience has evolved along its first year. MATERIAL AND METHOD: Academic opinions of directly involved leading Professors of the Program are summarized and presented. RESULTS: Program design kept same objectives than the original 3 years program but doubled to 6 years to give place to primary care shifts. This requirement led to the implementation of several measures (strict records for academic experiences, grades, decisions, permissions; follow up and regular evaluation meetings with all involved people), academic creativity as well as the development of higher flexibility than the traditional three years program. CONCLUSIONS: Up to this moment experience has shown highly satisfactory and stimulant characteristics for the Faculty. No major difficulties have occurred and students declare satisfaction. Among several additional observed advantages students have linked their original working places and hospital with clear benefits for served population. This has become a major strength providing better consistency to the health network. Naturally, all aspects to make a sound evaluation of the experience will be kept under close surveillance. There is a plain belief that by the end of the training period specialist level will be comparable to the traditional specialization program.
Subject(s)
Humans , Primary Health Care , Education, Medical, Graduate , Medicine , ChileABSTRACT
Background: HYrthle cells can be found in non malignant thyroidal diseases such as Basedow Graves and Hashimoto diseases. When HYrthle cells comprise more the 75 percent of cellularity, they become a neoplasm. There are malignant variants of these neoplasms, constituted by follicular and papillary HYrthle cell carcinomas. Aim: To report a 41 years experience with HYrthle cell carcinomas of the thyroid. Material and methods: A retrospective review of all patients operated for a thyroid carcinoma and selection of those patients with HYrthle cell carcinoma of the thyroid. Results: Twenty two patients (21 female, mean age 48 years old) with HYrthle cell carcinoma of the thyroid were selected. Total or near total thyroidectomy was the treatment of choice in 20 and 19 received 131I. Metastatic involvement of cervical lymph nodes was found in five patients and they underwent modified cervical lymph node dissection. During follow up, only one patient died of the disease. We did not find higher incidences of local recurrences, distant metastases or mortality rates, compared to well differentiated thyroid carcinomas. Conclusions: HYrthle cell carcinomas of the thyroid and well differentiated thyroid carcinomas have similar biological behaviors. Their treatment should be similar, including total or near total thyroidectomy plus modified cervical node dissection when there is lymph node involvement. Radioactive iodine therapy and suppressive levothyroxin therapy should follow
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thyroid Neoplasms/surgery , Adenoma, Oxyphilic/surgery , Thyroidectomy , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathology , Goiter , Adenoma, Oxyphilic/diagnosis , Adenoma, Oxyphilic/pathology , Iodine Radioisotopes/therapeutic useABSTRACT
We report 5 cases of insular carcinoma of the thyroid. Most patients were females (80 percent) with an age range of 28 to 75 years. Treatment consisted of total or near total thyroidectomy plus modified cervical lymph node dissection in cases with lymph node metastasis. This was followed by radioiodine therapy and external radiation therapy in patients with residual disease. None of the patients had distant metastasis. However, three patients with involvement of the perithyroid soft tissue died within 4 years of the diagnosis. The other two patients are alive without evidence of disease. This type of thyroid carcinoma has an aggresive clinical course with frequent extension to the adjacent soft tissue associated to poor outcome
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Thyroid Neoplasms/diagnosis , Carcinoma , Thyroidectomy , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Thyroid Neoplasms/radiotherapy , Follow-Up Studies , Iodine Radioisotopes/therapeutic use , Radioisotope TeletherapyABSTRACT
Fine needle aspiration biopsy (FNAB) is the most usuful preoperative work up method for patients with nodular goiter. We analyze 173 patients that underwent FNAB and were subsequently operated. The sample obtained with FNAB was processed both for cytological and histological study, using methods developed at the hospital. The preoperative diagnosis reached was compared with that obtained with the surgical piece. Results showed that the the histological analysis of the FNAB sample improved the sensitivity of the method, when compared with the cytological study, from 68,5 percent to 87.8 percent (p<0,035) without modifying specificity (100 percent for both methods). It is concluded that FNAB with histological study of the sample has a high diagnostic yield and is exempt of complications