[Psychopathology screening in medical school students]. / Sistema de tamizaje de psicopatología en estudiantes de Medicina.

OBJECTIVE: Screening of psychopathology and associated factors in medical students employing an electronic self-report survey. METHOD: A transversal, observational, and comparative study that consisted of the following instruments: Sociodemographic survey; 2. Adult Self-Report Scale-V1 (ASRS); State-Trait Anxiety Inventory (STAI); Zung and Conde Self-Rating Depression Scale, Almonte-Herskovic Sexual Orientation Self-Report; Plutchik Suicide Risk Scale; Alcohol Use Disorders Identification Test Identification (AUDIT); Fagerström Test for Nicotine Dependence; 9. Maslach Burnout Inventory (MBI); Eating Disorder Inventory 2 (EDI). RESULTS: We gathered 323 student surveys from medical students of the first, third and sixth grades. The three more prevalent disorders were depression (24%), attention deficit disorders with hyperactivity (28%) and anxiety (13%); the prevalence of high-level burnout syndrome was 13%. Also, the fifth part of the students had detrimental use of tobacco and alcohol. CONCLUSION: Sixty percent of medical students had either one or more probable disorder or burnout. An adequate screening and treatment of this population could prevent severe mental disorders and the associated factors could help us to create a risk profile. This model is an efficient research tool for screening and secondary prevention.

Selective packing for uncontrollable traumatic thoracic wall bleeding preserving cardiopulmonary function.

BACKGROUND: Uncontrollable chest wall bleeding secondary to thoracic trauma has been a challenging problem faced by surgeons. Thoracic packing has been described as a good alternative although most thoracic surgeons avoid it because of the potential deleterious effects on cardiopulmonary function. METHODS: We describe a selective gauze packing technique of the thoracic wall preserving cardiopulmonary function in 3 patients with uncontrollable bleeding, where gauze packs were placed on bleeding areas holding them in a "sandwich-like" arrangement between the skin and the pleura and tightly fixed with coated wire stitches using internal and external-thoracic Ventrofil® devices. RESULTS: Successful hemostasis and cardio-respiratory stability were achieved in all cases after selective packing. X-ray showed acceptable lung expansion and no heart compression. CONCLUSIONS: This selective packing technique is simple, feasible and highly effective in managing uncontrollable post-traumatic or even post-operative chest wall hemorrhages when the life of patients is in danger.

Prototype selection for nearest neighbor classification: taxonomy and empirical study.

The nearest neighbor classifier is one of the most used and well-known techniques for performing recognition tasks. It has also demonstrated itself to be one of the most useful algorithms in data mining in spite of its simplicity. However, the nearest neighbor classifier suffers from several drawbacks such as high storage requirements, low efficiency in classification response, and low noise tolerance. These weaknesses have been the subject of study for many researchers and many solutions have been proposed. Among them, one of the most promising solutions consists of reducing the data used for establishing a classification rule (training data) by means of selecting relevant prototypes. Many prototype selection methods exist in the literature and the research in this area is still advancing. Different properties could be observed in the definition of them, but no formal categorization has been established yet. This paper provides a survey of the prototype selection methods proposed in the literature from a theoretical and empirical point of view. Considering a theoretical point of view, we propose a taxonomy based on the main characteristics presented in prototype selection and we analyze their advantages and drawbacks. Empirically, we conduct an experimental study involving different sizes of data sets for measuring their performance in terms of accuracy, reduction capabilities, and runtime. The results obtained by all the methods studied have been verified by nonparametric statistical tests. Several remarks, guidelines, and recommendations are made for the use of prototype selection for nearest neighbor classification.

Minimally-invasive resection of a scapular osteochondroma.

Osteochondroma of the scapula is a rare benign tumour that produces pain and mechanical dysfunction of the joint when settled on the ventral surface of the scapula. Surgical resection is the treatment of choice in symptomatic cases. Conventional open excision has been the traditional treatment of choice, while published cases involving a minimally-invasive approach are rare and restricted to descriptions of video-assisted procedures. We present a case of video-assisted surgical resection of a large osteochondroma from the ventral surface of the scapula in a young male patient with the snapping scapula syndrome. The technique and the postoperatory outcome are described.

New minimally invasive technique for correction of pectus carinatum.

We describe a new video-assisted operative technique for correction of pectus carinatum (PC) using a modified Nuss procedure. A new design of the steel bar was developed, so that it could be introduced and placed in a suitable position through very small skin incisions. Substantial modifications were introduced in the bar length and shape aimed at facilitating insertion and subsequent removal when required. All the surgical manoeuvres took place under direct vision using a 30° thoracoscope. Single unilateral fixation of the bar in a subpectoral pocket provided satisfactory stabilisation without the need for lateral stabilisers. Adequate correction of the deformity was achieved with minor postoperative scars. Our results support the view that minimally invasive surgical repair should be preferred over open surgery for correction of pectus carinatum in young adults and children.

Trasplante unipulmonar infantil en paciente con fibrosis quística / No disponible

No disponible

New technique for pulmonary artery reconstruction.

Bronchial and vascular reconstructive procedures are a technically feasible alternative to pneumonectomy in lung cancer and have the advantage of preserving lung parenchyma function. Sleeve resection and prosthetic reconstruction of the pulmonary artery (PA) have progressively gained acceptance as an alternative to pneumonectomy in lung cancer surgery. To spare the lung parenchyma, angioplastic procedures involving removal of a portion of the arterial wall or a circumferential resection with arterial reconstruction have been used. Several techniques of pulmonary arterioplasty have been documented, such as patch reconstruction, end-to-end anastomosis, synthetic prosthesis, biological prosthesis, prosthetic or pericardial conduit. We present the first case reported in the literature of PA reconstruction with a pulmonary vein graft.

Incidence, management and clinical outcomes of patients with airway complications following lung transplantation.

OBJECTIVE: Airway complications (AC) remain a significant contributing factor of morbidity after lung transplantation (LT). The aim of this study was to identify risk factors for AC, and to review the outcomes after endoscopic and surgical treatment. METHODS: From 1993 to 2006, 255 patients underwent LT. Seven retransplants and 34 patients not surviving beyond 7 days were excluded. The remaining patients were: 124 double LT (DLT), 85 single LT (SLT), 3 lobar LT and 2 liver-DLT, comprising 343 bronchial anastomoses at risk. Donor lungs were flushed with either modified Eurocollins or Perfadex. Bronchial anastomoses were telescoped when needed. Donor and recipient variables were recorded and analyzed by univariate and multivariate tests to identify risk factors for AC, and to assess differences between both complicated and non-complicated groups. RESULTS: Among 343 bronchial anastomoses, 31 presented AC (9%) in 27 patients (12.6%): 22 stenoses, 5 dehiscences, and 4 malacias, at 2.6+/-1.7 months post-transplant. Indications were 7 emphysema, 3 Alpha-1-antitrypsin deficiency, 12 cystic fibrosis (p=0.007), 4 pulmonary fibrosis, and 1 bronchiectasis. AC were observed in 4 SLT and 23 DLT (p=0.005). Incidence of AC did not differ between telescoped and non-telescoped anastomoses. By univariate analysis, AC were more frequent in grafts preserved with modified Eurocollins (p=0.033), CMV infection/disease (p=0.027) and airway colonizations post-transplant (p=0.021). Other donor and recipient variables did not differ between groups. By multivariate analysis, intubation longer than 72 h, DLT, and airway colonizations post-transplant remained independently associated with AC. Survival did not differ between groups. Most patients were successfully treated with endoscopic procedures; three required reoperation (lobectomy, pneumonectomy, retransplantation). AC related mortality was 1%. CONCLUSIONS: The incidence of AC after LT is 12.6% with a related mortality of 1%, irrespective of the technique of bronchial anastomosis performed. DLT, airway colonizations, and prolonged intubation post-transplant are associated with AC. Either endoscopic procedures or surgical therapy resolve these complications in most cases.

Triton tumor of the left sympathetic nerve.

Malignant triton tumor is a subtype of malignant peripheral nerve sheath tumor which presents a rabdomyoblastic differentiation. We report the case of a 14-year-old male with a radical surgical resection of a mediastinal malignant triton tumor of the sympathetic nerve, a rare location for this tumor. Thereafter, he received adjuvant radiotherapy and was reoperated three months later for an early local recurrence. The prognosis for this group of tumors is poor. Radical surgical excision of the tumor followed by radiation therapy must be the treatment of choice.