Tratamiento definitivo de las lesiones premalignas de la mama sin cirugía: la escisión percutánea Intact R-BLES / Definitive treatment of premalignant breast lesions without surgery: the Intact R-Breast Lesion Excision System (BLES)

Objetivo. El hallazgo en una biopsia de mama de lesiones proliferativas atípicas, implica la necesidad de cirugía y extirpación de dicha lesión. El objetivo del estudio fue determinar la tasa de escisiones completas mediante el uso del dispositivo IntactR-BLES de lesiones categorizadas B3 en biopsia asistida por vacío (BAV). Pacientes y métodos. Realizamos un estudio descriptivo observacional de la utilidad de este sistema que consigue, con anestesia local y ambulatoriamente, la obtención percutánea de una muestra de tejido de 20 × 20 mm, permitiendo la valoración de los márgenes de resección, llevado a cabo entre febrero de 2012 y septiembre de 2014. Resultados. Se analizaron 25 procedimientos. La biopsia inicial demostraba principalmente la presencia de atipia epitelial plana (56%) e hiperplasia ductal atípica (32%). El tamaño medio de la pieza extirpada fue de 20 × 10 × 8 mm, en un espécimen único, permitiendo la valoración de márgenes en todas ellas (100%). En el estudio anatomopatológico definitivo no se encontró lesión residual en el 68% de los casos, así como 2 casos (8%) de carcinoma intraductal (CDIS), infradiagnosticados con la biopsia inicial. El estudio de márgenes demostró estar libres en el 85% de los casos. No ha habido ningún efecto adverso importante, solo un caso de hematoma y un caso de dolor superior al normal. Conclusiones. El sistema de escisión percutánea (Intact®-BLES) permite mediante un procedimiento con anestesia local, de forma ambulatoria y sin complicaciones importantes evitar la cirugía en un 88% de los casos de lesiones premalignas en la biopsia inicial. Así mismo, permite demostrar la presencia de CDIS en un 8% de los casos (infradiagnosticados) (AU)

Objective. The finding of an atypical proliferative lesion in a breast biopsy implies the need for surgical removal of the lesion. The aim of this study was to determine the complete excision rate with the IntactR-BLES device of B3 lesions diagnosed in vacuum-assisted biopsy. Patients and methods. A descriptive study was carried out to appraise the usefulness of this system, which obtains a percutaneous 20×20 mm tissue sample under local anaesthesia and on an outpatient basis, allowing assessment of the resection margins performed between February 2012 and September 2014. Results. We analysed 25 procedures. The initial biopsy showed mostly the presence of flat epithelial atypia (56%) and atypical ductal hyperplasia (32%). The mean size of the resected specimen was 20×10×8 mm, in a single specimen, allowing assessment of margins in all of them (100%). The definitive pathological analysis reported no residual lesion in 68% of the patients and intraductal carcinoma in situ (DCIS) in 2 patients (8%), which had been underdiagnosed with the initial biopsy. Study of margins also demonstrated free margins in 85% of the patients. There were no major adverse effects, and only 1 case of haematoma and 1 case of higher-than-normal pain. Conclusions. The percutaneous excision system (Intact®-BLES) can be performed under local anaesthesia on an outpatient basis without major complications, thus avoiding surgery in 88% of cases of premalignant lesions in the initial biopsy. In addition, this procedure revealed the presence of DCIS in 8% of the patients (underdiagnosed) (AU)

Cuatro años de experiencia con el libro informático del residente de la AEC / Four years experience with the AEC residents E-Book

Introducción La introducción del libro informático del residente, de la Asociación Española de Cirujanos (LIR-AEC), nos ha permitido realizar evaluaciones particulares y generales de cada residente. El objetivo ha sido conocer la media de actividades asistenciales, científicas y quirúrgicas según el programa de la especialidad. Material y método Registro de la actividad de los residentes en el LIR-AEC. Se ha cuantificado la actividad general por año y por rotación. Se ha analizado la relación de intervenciones asistidas y realizadas y según grados de complejidad. La media de actividades científicas y asistenciales y la de guardias al mes. Resultados Desde 2004, 8 residentes han registrado su actividad en el LIR-AEC. Asisten a una media de 1.514 intervenciones, de las cuales realizan como cirujano 922 (62%). Asisten a 185 intervenciones laparoscópicas, de las que realizan 72 (39%). Como cirujanos, 864 (94%) de los 922 procedimientos son de los niveles 1, 2 y 3 (el 64, el 75 y el 53%, respectivamente). Realizan una media de 5,75 guardias por mes. Acuden de media durante la residencia a un total de 21 cursos y congresos. Participan en un total de 24 comunicaciones y pósters, así como en 6 publicaciones de media en la residencia. Conclusiones El LIR-AEC permite una evaluación continua de la actividad del residente. Hemos podido conocer la media de actividades que realiza cada residente durante una rotación y un año determinados, esto permite conocer con exactitud si se cumplen los mínimos definidos (AU)

Material and method A register of the activities of residents in the AEC-E-Book. The overall activity per year and per rotation has been measured. The relationships of assisted interventions performed and their level of complexity have been analysed. The mean scientific and health care activities and the mean on-call periods per month. Results A total of 8 residents have registered their activity in the AEC-E-Book since the year 2004. They assisted in a mean of 1514 operations, of which 922 were performed as surgeon (62%). They assisted in 185 laparoscopic interventions, of which they performed 72 (39%). As surgeon, 864 (94%) of the 922 procedures 64% were level 1, 75% level 2, and 53% were level 3. They were on-call a mean of 5.75 times per month. They attended a total of 21 courses and congresses during residency. They took part in 24 presentations and posters, as well as in 6 journal publications during residence. Conclusions The AEC-E-Book enables the activity of the resident to be continually assessed. We have been able to find out the mean activities carried out by each resident during a particular rotation and year, thus being able to know exactly if they have fulfilled the defined minimums (AU)

[Four years experience with the AEC residents E-Book]. / Cuatro años de experiencia con el libro informático del residente de la AEC.

INTRODUCTION: The introduction of the Spanish Association of Surgeons resident's electronic book (AEC-E-Book), has meant that we can perform particular and overall assessments of each resident. The objective of this article has been to find out the mean health care, scientific and surgical activities according to the speciality program. MATERIAL AND METHOD: A register of the activities of residents in the AEC-E-Book. The overall activity per year and per rotation has been measured. The relationships of assisted interventions performed and their level of complexity have been analysed. The mean scientific and health care activities and the mean on-call periods per month. RESULTS: A total of 8 residents have registered their activity in the AEC-E-Book since the year 2004. They assisted in a mean of 1514 operations, of which 922 were performed as surgeon (62%). They assisted in 185 laparoscopic interventions, of which they performed 72 (39%). As surgeon, 864 (94%) of the 922 procedures 64% were level 1, 75% level 2, and 53% were level 3. They were on-call a mean of 5.75 times per month. They attended a total of 21 courses and congresses during residency. They took part in 24 presentations and posters, as well as in 6 journal publications during residence. CONCLUSIONS: The AEC-E-Book enables the activity of the resident to be continually assessed. We have been able to find out the mean activities carried out by each resident during a particular rotation and year, thus being able to know exactly if they have fulfilled the defined minimums.

[A prospective, randomised, controlled study on the need to mechanically prepare the colon in scheduled colorectal surgery]. / Estudio prospectivo controlado y aleatorizado sobre la necesidad de la preparación mecánica de colon en la cirugía programada colorrectal.

INTRODUCTION: Mechanical preparation of the colon (MPC) in colorectal surgery has been a dogma that has been questioned over the last few years. The objective of this study is to demonstrate that morbidity in scheduled colorectal surgery is the same or lower without MPC. MATERIAL AND METHOD: Patients subjected to scheduled left colon and rectal surgery with primary anastomosis randomised into two groups. The "Preparation" group (MPC) received MPC and the "non-preparation" group (No-MPC) had only cleaning enemas. The variables collected were: demographic, oncological, nutritional, risk prediction models and morbidity-mortality. RESULTS: Of the 193 patients included: 69 received MPC and 71 did not; 89 patients with colocolic anastomosis (MPC, 38; no MPC, 51) and 50 colorectal (MPC, 31; no MPC, 19). Statistically significant differences were seen in the overall analysis in favour of "no preparation" as regards morbidity (43.55 % with MPC and 27% with No MPC) and nosocomial infection (27.5% and 11.4%). There was 11.6% wound infections in the MPC compared to 5.7% in the no MPC, which was not statistically significant. The only mortalities were in the MPC group 2/69 (2.9% of patients). As regards the location of the anastomosis, in the colocolics the differences were more pronounced, with statistically significant differences in the morbidity, anastomosis dehiscence, and nosocomial infection variables. The effect of no MPC was not so evident in colorectal anastomosis. CONCLUSIONS: Our results suggest that there is no benefit in MPC before surgery in colocolic anastomosis. No-MPC is not associated with a higher morbidity in wound infection or anastomotic dehiscence. In colorectal anastomosis the differences are not so evident, therefore a much bigger series needs to be studied.

Estudio prospectivo controlado y aleatorizado sobrela necesidad de la preparación mecánica de colonen la cirugía programada colorrectal / A prospective, randomised, controlled study on the need to mechanically prepare the colon in scheduled colorectal surgery

Introducción: la preparación mecánica de colon (PMC) en la cirugía colorrectal es un dogma que se ha cuestionado en los últimos años. El objetivo de este estudio es demostrar que la morbilidad en cirugía programada colorrectal es igual o menor sin la PMC. Material y método: pacientes sometidos a cirugía programada de colon izquierdo y recto con anastomosis primaria fueron aleatorizados en dos grupos. Al grupo PMC se le practicó la preparación y al grupo sin PMC, sólo enemas de limpieza. Se recogieron variables demográficas, oncológicas, nutricionales y quirúrgicas, modelos de predicción de riesgo y morbimortalidad. Resultados: se incluyó a 193 pacientes, 69 con PMC y 71 sin ella; 89 pacientes con anastomosis colocólica (PMC, 38; sin PMC, 51) y 50 con anastomosis colorrectal (PMC, 31; sin PMC,19). En el análisis general, se apreciaron diferencias estadísticamente significativas a favor de no preparar en cuanto a la morbilidad (el 43,5% en el PMC y el 27% en los sin PMC) e infección nosocomial (el 27,5 y el 11,4%). En la infección de herida, sin diferencias estadísticamente significativas, se obtuvo el 11,6% en el PMC, frente al 5,7% en el sin PMC. Las únicas muertes fueron 2/69 (2,9%) pacientes en el grupo PMC. Según localización de anastomosis, en las colocólicas las diferencias fueron más acusadas y estadísticamente significativas en las variables morbilidad, dehiscencia de anastomosis e infección nosocomial. en las anastomosis colorrectales no fue tan evidente el efecto de no preparar. Conclusiones: nuestros resultados indican que no existe un beneficio de la PMC en la cirugía ante anastomosis colocólicas. No preparar no tiene relación con más morbilidad en infección de herida ni dehiscencia anastomótica. En anastomosis colorrectales, las diferencias no tan evidentes hacen necesarias series más amplias (AU)

Introduction: Mechanical preparation of the colon (MPC) in colorectal surgery has been a dogma that has been questioned over the last few years. The objective of this study is to demonstrate that morbidity in scheduled colorectal surgery is the same or lower without MPC. Material and method: Patients subjected to scheduled left colon and rectal surgery with primary anastomosis randomised into two groups. The “Preparation” group (MPC) received MPC and the “non-preparation” group (No-MPC) had only cleaning enemas. The variables collected were: demographic, oncological, nutritional, risk prediction models and morbidity-mortality. Results: Of the 193 patients included: 69 received MPC and 71 did not; 89 patients with (..) (AU)

[How are resident physicians evaluated? The residents' computerized activity record]. / 'Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente.

INTRODUCTION: Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. MATERIAL AND METHOD: The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. RESULTS: The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. CONCLUSIONS: The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training.

¿Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente / How are resident physicians evaluated? The residents’ computerized activity record

Introducción. La evolución de nuestra especialidad en los últimos años obliga a realizar actualizaciones no sólo en contenidos, sino en una evaluación de los conocimientos aprendidos. El objetivo de este artículo es presentar nuestra experiencia en un modelo de evaluación integral. Se basa en una valoración de los conocimientos teóricos y las habilidades quirúrgicas. Material y método. El programa de formación para los MIR que hemos aplicado está fundamentado en 4 apartados: asistencial, formación continuada, investigación (doctorado) y control de la actividad realizada (libro informático del residente). Permite una evaluación de los conocimientos teóricos y las habilidades aprendidas al final de cada rotación. Mediante la creación del libro informático del residente que presentamos, se practica cada 6 meses una cuantificación de la actividad de forma continua y comparada. Resultados. En julio de 2004, iniciamos la puesta en marcha de este sistema de evaluación de la actividad de los residentes. Se entregó a cada uno de ellos su propia base de datos para que iniciara su desarrollo mediante la introducción de todas las actividades realizadas. Se presentan los resultados de la actividad global y particular de cada residente. Conclusiones. El método que utilizamos permite seguir la evolución integral del residente y realizar, al final de cada año y de la residencia, una valoración totalmente objetiva. La generalización de este método o uno similar facilitará la realización de comparaciones con otros centros y bajo premisas similares. Por otra parte, podría unificar criterios y determinar desviaciones de formación (AU)

Introduction. Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. Material and method. The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. Results. The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. Conclusions. The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training (AU)