ABSTRACT
Introduction: The national Society of Surgery has defined the minimum number of surgical procedures that must be performed by general surgeons in trainee, however, there is no national data reporting this accomplishment. The aim of this study is to report on detail the surgical interventions performed by General Surgery Residents at the Pontificia Universidad Catolica de Chile (PUC) as lead surgeons. Methods: Retrospective analysis of surgical procedures performed by 26 Residents of the General Surgery Program (GSP) at PUC who graduated between the years 2012 and 2014. A total of 10.102 registered surgeries were reviewed and summarized. Results: The mean number of interventions performed by surgery residents was 481 (20% of them on the first year). The most frequently performed procedures were (mean per resident) laparoscopic cholecystectomy (115;24%), open appendectomy (89;19%), classic hernioplasty (43;9%), laparoscopic appendectomy (34;7%) and open cholecystectomy (25;5%). Regarding complex/sub-specialty interventions, partial/ total colectomy (12;2%), thyroidectomy-parathyroidectomy (9;2%), vascular access (8;2%), thoracotomy-VATS-sternotomy (5;1%) and breast surgery (4;1%) were the most commonly performed. Fifty three percent of all procedures were done in an emergency setting. The proportion of emergency procedures increased through the GSP training (elective vs emergency: 62 vs 38% at first year and 34 vs 66% at third year, respectively; p < 0.002). Interventions were mainly performed in the capital city of Chile, Santiago (74%) and the remaining were done in other provinces. Regarding only abdominal interventions (mean per resident: 366), 42% was performed by laparoscopy. Conclusions: Residents of the PUC-GSP execute a considerable large amount of interventions as resident surgeons throughout their 3-years-training program, exceeding the minimum recommendations established by the national Society of Surgery.
Introducción: Se han definido objetivos mínimos para la formación de Cirujanos Generales, pero no existen publicaciones que den cuenta del cumplimiento de los mismos. El objetivo de este trabajo es comunicar un análisis descriptivo de las intervenciones quirúrgicas realizadas por los residentes del Programa de Cirugía General (PCG) de la Pontificia Universidad Católica de Chile (PUC) en rol de primer cirujano. Material y Método: Se solicitó el registro de operaciones realizadas en rol de 1er cirujano a los 26 egresados entre 2012-2014 del PCG. Se realizó un análisis descriptivo de las 10.102 operaciones registradas. Resultados: El promedio de intervenciones realizadas por residente fue de 481 (20 por ciento en 1er año). Las más frecuentes fueron: colecistectomía laparoscópica (115;24 por ciento), apendicectomía clásica (89;19 por ciento), hernioplastía (43;9 por ciento), apendicectomía laparoscópica (34;7 por ciento) y colecistectomía clásica (25;5 por ciento). Las operaciones de especialidades derivadas que más se realizaron: colectomía (12;2 por ciento); tiroidectomía-paratiroidectomía (9;2 por ciento), accesos vasculares (8;2 por ciento), toracotomía-VATS-esternotomía (5;1 por ciento) y cirugía mamaria (4;1 por ciento). Un 53 por ciento de las intervenciones fueron de urgencia, observándose una inversión de la proporción entre procedimientos electivos vs de urgencia a lo largo de la formación (62 vs 38 por ciento en 1ro y 34 vs 66 por ciento en 3ro; p < 0,002). De las intervenciones abdominales (366), 58 por ciento fue por laparotomía y 42 por ciento por laparoscopia. Un 74 por ciento y 26 por ciento de todas las intervenciones se realizaron en centros de Santiago y regiones, respectivamente. Conclusiones: Los residentes de la PUC completan un volumen importante de intervenciones en rol de primer cirujano durante los 3 años de su PCG, superando las exigencias mínimas establecidas.
Subject(s)
Humans , Clinical Competence , General Surgery , Internship and Residency , Retrospective StudiesABSTRACT
Background: Inflammation is a common phenomenon present in gastric mucosa of patients infected with H. pylori. Activation of the RAGE/multiligand axis is thought to be a relevant factor in cancer-mediated inflammation. RAGE is a membrane receptor, belonging to the immunoglobulin family, and the over-expression of RAGE has been associated with increased invasiveness and metastasis generation in different types of cancer, including gastric cancer. Furthermore recent experiences show that the use of its soluble form (sRAGE) or silencing of the gene coding for this receptor could provide therapeutic benefits in cancer. Aim: To evaluate the immunohistochemical expression of RAGE, MUC-1, β-Catenin free and phosphorylated, Cyclin-D1 and GSK3 in gastric biopsy specimens infected with H. pylori. Material and Methods: Immunohistochemical analysis was carried out in gastric biopsies from 138 patients: 55 with inflammatory injury (no atrophic gastritis), 42 with pre-cancerous conditions (atrophy or intestinal metaplasia) and 41 with dysplastic lesions or in situ adenocarcinoma. Results: There was a high rate of positive RAGE expression in the three groups of biopsies. Biopsies with dysplasia or in situ carcinoma had a significantly higher percentage of RAGE expression than the other groups of biopsies. Conclusions: The increased RAGE expression reported in both dysplasia and incipient cancer support the role of the multiligand/RAGE axis in gastric carcinogenesis.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Gastric Mucosa/chemistry , Helicobacter pylori , Precancerous Conditions/chemistry , Receptors, Immunologic/analysis , Stomach Neoplasms/chemistry , Biomarkers/analysis , Biopsy , Cyclin D1/analysis , Gastric Mucosa/microbiology , /analysis , Helicobacter Infections/metabolism , Immunohistochemistry , Mucin-1/analysis , beta Catenin/analysisABSTRACT
La perforación de una úlcera péptica corresponde a una infrecuente y siempre grave complicación de la enfermedad ulcerosa. El tratamiento quirúrgico es la terapia de elección. Se operaron 22 pacientes (21 hombres) con una edad promedio de 50 años. Tres enfermos tenían el diagnóstico de úlcera péptica previo a la emergencia actual. El síntoma más frecuente de consulta fue el dolor epigástrico de inicio súbito en 21 (95,4 por ciento) pacientes. El diagnóstico se realizó con radiografía de tórax de pie o de abdomen simple en 11 enfermos. Se realizó sutura simple de la úlcera en 12 (54,5 por ciento) pacientes, sutura más epiploplastía en 7 (31,8 por ciento) y resección gástrica en tres enfermos (13,6 por ciento). Siete (31,8 por ciento) pacientes presentaron complicaciones post operatorias, de los cuales fallecieron 2 (9,1 por ciento) como consecuencia de la sepsis asociada. Se realizó un seguimiento endoscópico a 9 pacientes (45 por ciento) sobrevivientes al episodio agudo. En 5 de ellos se demostró que la úlcera péptica aun permanecía activa. A dos de estos últimos pacientes se les realizó, en forma electiva una cirugía resectiva definitiva. Se concluye que la perforación de una úlcera péptica corresponde a un cuadro grave, que se asocia a una morbilidad y mortalidad significativa. El tratamiento quirúrgico local es la terapia de elección para el episodio agudo, sin embargo este no es definitivo y no evita la recidiva.
Background: Peptic ulcer perforation is an uncommon by devastating complication that requires emergency surgical treatment. Aim: To review the results of surgical treatment of peptic ulcer perforation in a Chilean Regional Hospital. Material and Methods: Retrospective review of medical records of 22 patients (age range 21-88 years, 21 males) operated for a perforated peptic ulcer, between 1995 and 2000. Results: The most common presentation symptom was acute epigastric pain in 21 patients. The diagnosis was done with a plain abdominal X ray obtained in the standing position, in 11 patients. A simple suture of the ulcer was done in 12 patients, suture plus epiploplasty in seven and gastric resection in three. Seven patients (32 percent) had postoperative complications and two (9 percent) died as a consequence of an associated septic process. An endoscopic follow up was done in nine patients and in two, the peptic ulcer remained active. These two patients were subjected to an elective excisional surgery. Conclusions: Local surgical correction of peptic ulcer perforation is the emergency treatment of choice but does not avoid ulcer relapse.