Comparison of flipped learning and traditional lecture method for teaching digestive system diseases in undergraduate medicine: A prospective non-randomized controlled trial.

INTRODUCTION: This study examined the effects of a large-scale flipped learning (FL) approach in an undergraduate course of Digestive System Diseases. METHODS: This prospective non-randomized trial recruited 404 students over three academic years. In 2016, the course was taught entirely in a Traditional Lecture (TL) style, in 2017 half of the course (Medical topics) was replaced by FL while the remaining half (Surgical topics) was taught by TL and in 2018, the whole course was taught entirely by FL. Academic performance, class attendance and student's satisfaction surveys were compared between cohorts. RESULTS: Test scores were higher in the FL module (Medical) than in the TL module (Surgical) in the 2017 cohort but were not different when both components were taught entirely by TL (2016) or by FL (2018). Also, FL increased the probability of reaching superior grades (scores >7.0) and improved class attendance and students' satisfaction. CONCLUSION: The holistic FL model is more effective for teaching undergraduate clinical gastroenterology compared to traditional teaching methods and has a positive impact on classroom attendances.

Apendicitis crónica del muñón apendicular como causa de dolor abdominal crónico / Chronic stump appendicitis as a cause of chronic abdominal pain

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Tratamiento del fallo hepático después de hepatectomía mediante sistema de diálisis hepática MARS / Treatment of hepatic failure after hepatectomy by the MARS hepatic dialysis system

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Hepatolitiasis en la fibrosis quística: una condición especial para el tratamiento quirúrgico / Hepatolithiasis in cystic fibrosis: A special condition for surgical treatment

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Which patients benefit most from laparoscopic ventral hernia repair? A comparative study.

PURPOSE: To establish which patients suffering ventral hernia benefit the most from laparoscopic approach. METHODS: From January 2005 to October 2008, 126 patients underwent surgery due to incisional hernia at our University Hospital. Patients were assigned to laparoscopic surgery (n=60) or conventional surgery (n=66) at the surgeon's discretion. Patients were subdivided according to the greater diameter of the defect: (G1, defect <5 cm; G2, defect 5 to 15 cm; and G3, defect >15 cm). Data on patient demographic, clinical, and perioperative variables were collected prospectively. RESULTS: Groups were comparable in terms of sex, body mass index, American Society of Anesthesiologists score, size of defect, and proportion of primary repairs. Four patients were converted to open surgery. Mean hospital stay in the group with the smaller hernias (G1 was 3.16 d laparoscopic surgery vs. 2.87 d conventional surgery, P>0.05). Hospital stay for patients who underwent laparoscopy was shorter in G3 (4.25 d Lap vs. 12.6 d Open; P=0.02). CONCLUSIONS: Patients with very large incisional hernias are those who benefit the most from laparoscopic treatment.

Posttraumatic Intrasplenic Pseudoaneurysm with High-Flow Arteriovenous Fistula: New Lessons to Learn.

Intrasplenic pseudoaneurysm is a potentially lethal complication of abdominal trauma. We present the case of a 33-year-old patient with this particular complication diagnosed by CT-scan. Selective embolization was not possible due to its extraordinarily large size and finally splenectomy was performed. We review the English literature and discuss the particular role of the interventional radiologist to treat this entity. The interventional radiologist is the specialist who better estimates the success of embolization or the risk and possibility of delayed splenic rupture. Embolization of the arterial tributary to the pseudoaneurysm should be considered as the treatment of choice only when the diagnosis is made before rupture of the spleen and only in selected cases. Splenectomy always remains as an alternative treatment for high-risk pseudoaneurysms.

Rotura no traumática del bazo: experiencia con 10 casos / Atraumatic rupture of the spleen: experience of 10 cases

La rotura espontánea del bazo es una situación clínica infrecuente que puede atribuirse a diferentes causas. Se presenta la experiencia recopilada retrospectivamente de 10 casos de rotura esplénica acumulados durante 12 años. En nuestra serie de 10 pacientes con rotura atraumática hubo 7 casos de rotura patológica. En los 3 pacientes restantes, la rotura se consideró espontánea. Sin embargo, 2 de estos pacientes eran obesos mórbidos, cuya posible asociación aún no se ha descrito en la literatura médica. Realizamos una revisión de la bibliografía para discutir la etiología, la patogenia y el tratamiento óptimo de esta afección clínica

The most common cause of splenic rupture is trauma. Less frequently the spleen ruptures due to an ongoing hematologic, infectious or tumoral disease (pathologic rupture). We present a series of 10 patients with atraumatic splenic rupture: in seven patients there was a pathologic rupture. Two of the remaining three patients with spontaneous rupture were morbidly obese; this association has not previously been reported. The present review discusses the etiology, pathogenesis and optimal treatment of this entity

[Atraumatic rupture of the spleen: experience of 10 cases]. / Rotura no traumática del bazo: experiencia con 10 casos.

The most common cause of splenic rupture is trauma. Less frequently the spleen ruptures due to an ongoing hematologic, infectious or tumoral disease (pathologic rupture). We present a series of 10 patients with atraumatic splenic rupture: in seven patients there was a pathologic rupture. Two of the remaining three patients with spontaneous rupture were morbidly obese; this association has not previously been reported. The present review discusses the etiology, pathogenesis and optimal treatment of this entity.

Recurso técnico para el tubo de Kehr de difícil extracción / Technical resource for hazardous Kehr T-tube withdrawal

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Impact of previous abdominal surgery on colorectal laparoscopy results: a comparative clinical study.

To assess the results of laparoscopic colorectal surgery in patients who have previously undergone abdominal surgery. Between November 2002 and June 2004, 86 patients underwent laparoscopic surgery for colorectal disease at our hospital. Patients were divided into 2 groups depending on whether they had previously undergone abdominal surgery (previous surgery group, n = 27) or not (nonprevious surgery group, n = 59). Data were prospectively collected for statistical analyses of demographic, clinical, and histologic variables. Groups were comparable in age, body mass index, American Society of Anesthesiologists score, diagnosis, technique performed, and tumor size and distance to anal verge. There was no difference in perioperative complication rates. A higher conversion rate was found in the previous surgery group (26.1% vs. 5.1%, P = 0.02). In patients with tumor diseases, resection evaluations were no different regarding specimen length, distal and radial resection margins, or number of lymph nodes harvested. Laparoscopic colorectal surgery has proved to be a reliable technique for patients who have previously undergone abdominal surgery, its results comparable to those obtained with patients who have not.

[Implementation of laparoscopic rectal cancer surgery]. / Implementación de la cirugía del cáncer de recto por laparoscopia.

INTRODUCTION: The integration of laparoscopic surgery for rectal cancer in clinical practice is one of the challenges faced by surgical societies. The aim of the present study was to analyze the results obtained during the implementation phase of this technique. PATIENTS AND METHOD: From January 2003 to June 2005, 40 patients with rectal carcinoma underwent laparoscopic surgery in our center. Clinical and pathological variables were prospectively collected for statistical analyses. RESULTS: A total of 27 men and 13 women underwent surgery: 11 high (HAR) and 20 low anterior resections (LAR) and 9 abdominoperineal resections (APR) were performed. Operative time was 240.4 +/- 200 min and was greater in the LAR group (259.7 vs 201.5 min; p=.02). The intraoperative complication rate was 22.5% (9% HAR vs 25% LAR; p=NS). The mean length of hospital stay was 8.7 +/- 4.8 days. The rate of postoperative complications was 32.5%. The conversion rate was 15% (6 patients), and was greater in the LAR group (25% vs 0% HAR vs 11.1% APR; p=0.02). The most common intraoperative complication and the most frequent cause of conversion consisted of stapling problems (4 patients). Surgery was considered curative in 34 patients (85%). One case of positive radial margins was encountered (3.3%). The mean distal and radial margins were 3.6 +/- 2.7 cm and 1.1 +/- 0.9 cm respectively. CONCLUSIONS: The overall results during the implementation stage of laparoscopic surgery for rectal surgery were satisfactory. Conversion rates were highest in LAR, which proved to be the most demanding procedure.

The use of preoperative endoscopic tattooing in laparoscopic colorectal cancer surgery for endoscopically advanced tumors: a prospective comparative clinical study.

BACKGROUND: Endoscopic India ink marking techniques are often used for the intraoperative location of colonic polyps and early stage neoplasms. The aim of this study was to compare how effective this technique is compared with conventional localization methods, as well as its influence on the results of colorectal laparoscopy (LSCRC) for endoscopically advanced tumors. METHODS: From January 2003 to January 2005, 47 patients with colorectal carcinomas were included in the study. In one group, lesions were localized preoperatively by endoscopic India ink tattooing (n = 21; tattooed group, TG), while conventional methods were used in the others (n = 26; non-tattooed group, NTG). Patients' perioperative clinical and pathoanatomical data were prospectively collected. RESULTS: Both groups were comparable in age, sex distribution, American Society of Anesthesiologists (ASA) score, body mass index (BMI), technique performed, tumor size and proportion of patients who had previous abdominal surgery. Three patients presented ink spillage without clinical repercussions. Visualization of the correct resection site was higher in the TG (100% vs. 80.8%, P = 0.03). Operative time (147.3 +/- 46.2 vs. 187.0 +/- 52.7 minutes, P = 0.02) and blood loss (99.3 +/- 82.8 vs. 163.6 +/- 96.6 cc, P = 0.03) were lower in the TG. There were no differences between groups regarding peristalsis, introduction of oral intake, hospital stay or intra- and postoperative complication rates. No differences were observed amongst pathoanatomical data studied. CONCLUSIONS: Preoperative endoscopic tattooing is a safe and effective technique for intraoperative localization of advanced colorectal neoplasms, improving the operative results of LSCRC.

Implementación de la cirugía del cáncer de recto por laparoscopia / Implementation of laparoscopic rectal cancer surgery

Introducción. La incorporación de la cirugía laparoscópica del cáncer de recto (CLCR) en la práctica asistencial es uno de los retos que afrontan nuestras sociedades quirúrgicas. El objetivo del presente estudio es analizar los resultados obtenidos durante la fase de implementación de la técnica. Pacientes y método. Entre enero de 2003 y junio de 2005, en nuestro centro se intervino por laparoscopia a 40 pacientes con carcinoma rectal. Recogimos prospectivamente las variables clínicas y anatomopatológicas de los pacientes para su posterior análisis estadístico. Resultados. En 27 varones y 13 mujeres se realizaron 11 resecciones anteriores altas (RAA), 20 bajas (RAB) y 9 resecciones abdominoperineales (RAP). El tiempo quirúrgico fue de 240,4 ± 200 min, mayor para las RAB (259,7 min). La tasa de complicaciones intraoperatorias fue del 22,5% (n = 9). La estancia hospitalaria fue de 8,7 ± 4,8 días. La tasa de complicaciones postoperatorias fue del 32,5% (n = 13). La tasa de conversión fue del 15% (n = 6), mayor en el grupo de RAB (n = 5). Los problemas con la sección distal del recto, con 4 casos, fue la complicación intraoperatoria más frecuente y la causa más frecuente de conversión. Se consideró la cirugía como curativa en 34 casos (85%). Registramos 1 caso de margen de resección circunferencial (MRC) positivo (2,8%). Se obtuvo un margen longitudinal medio de 3,6 ± 2,7 cm y un MRC medio de 1,1 ± 0,9 cm. Conclusiones. Durante la fase de implementación de la CLCR obtuvimos unos resultados globales satisfactorios. La RAB se mostró como el procedimiento más exigente, con una mayor tasa de conversión (AU)

Introduction. The integration of laparoscopic surgery for rectal cancer in clinical practice is one of the challenges faced by surgical societies. The aim of the present study was to analyze the results obtained during the implementation phase of this technique. Patients and method. From January 2003 to June 2005, 40 patients with rectal carcinoma underwent laparoscopic surgery in our center. Clinical and pathological variables were prospectively collected for statistical analyses. Results. A total of 27 men and 13 women underwent surgery: 11 high (HAR) and 20 low anterior resections (LAR) and 9 abdominoperineal resections (APR) were performed. Operative time was 240.4 ± 200 min and was greater in the LAR group (259.7 vs 201.5 min; p=.02). The intraoperative complication rate was 22.5% (9% HAR vs 25% LAR; p=NS). The mean length of hospital stay was 8.7 ± 4.8 days. The rate of postoperative complications was 32.5%. The conversion rate was 15% (6 patients), and was greater in the LAR group (25% vs 0% HAR vs 11.1% APR; p=0.02). The most common intraoperative complication and the most frequent cause of conversion consisted of stapling problems (4 patients). Surgery was considered curative in 34 patients (85%). One case of positive radial margins was encountered (3.3%). The mean distal and radial margins were 3.6 ± 2.7 cm and 1.1 ± 0.9 cm respectively. Conclusions. The overall results during the implementation stage of laparoscopic surgery for rectal surgery were satisfactory. Conversion rates were highest in LAR, which proved to be the most demanding procedure (AU)

Inflammatory myofibroblastic tumor of the distal bile duct associated with lymphoplasmacytic sclerosing pancreatitis. Case report and review of the literature.

Inflammatory myofibroblastic tumor (IMT) or inflammatory pseudotumor has been described in various organs such as the liver, intestinal tract, spleen, kidney, bladder, lung, peritoneum and heart. However, its appearance in the periampullary region is uncommon and has rarely been reported in the literature. It is characterized histologically by myofibroblastic cell proliferation together with a mixed inflammatory infiltrate that clinically and radiologically mimics a malignant tumor. We report a case of IMT located in the distal common bile duct of a 51-year-old woman. She underwent Whipple resection with the initial diagnosis of cholangiocarcinoma; the pathologic diagnosis of the tumor was IMT of the distal bile duct associated with lymphoplasmacytic sclerosing pancreatitis. Referring to previously reported cases, suspected diagnosis of a malignant tumor made surgical excision the primary choice for symptom relief and in order to obtain a definitive diagnosis. IMT relationship with lymphoplasmacytic sclerosing pancreatitis is discussed.

A comparative clinical study of short-term results of laparoscopic surgery for rectal cancer during the learning curve.

OBJECTIVES: The aim of this study was to assess the results of laparoscopic surgery for rectal carcinoma (LSRC) during the learning curve throughout the introduction of this technique at our medical center. MATERIALS AND METHODS: From January 2003 to April 2004, 40 patients undergoing surgery were assigned to laparoscopic surgery group (LSG) (n=20) or conventional surgery group (CSG) (n=20). Data were prospectively collected to statistically analyze clinical, anatomopathological, and economic variables. RESULTS: Groups were comparable in age, sex, body mass index, American Society of Anesthesiologists score, surgical technique performed, tumor size and distance, Dukes' stage, and proportion of patients with previous abdominal surgery and radiotherapy. There was no difference in operative time. LSG blood loss was lower (p<.0001). LSG peristalsis and oral intake began earlier (p<.0001). LSG hospital stay was shorter (p<.0001). Intraoperative complications (10% LSG vs 15% CSG) and overall morbidity (35% LSG vs 45% CSG) were no different. LSG did not record any anastomotic leakages. Two patients (10%) were converted to open surgery. Regarding oncologic adequacy of resection, specimen length and number of nodes harvested were no different. LSG distal and radial resection margins were greater (p<.0001; p=.03). LSG operative costs were greater (p<.0001). However, CSG hospitalization costs were higher (p<.001). There was no overall difference (p=0.1). CONCLUSIONS: LSRC has been a reliable and efficient technique during the learning curve at our hospital.

Mucinous cystic neoplasm of the pancreas during pregnancy: the importance of proper management.

We describe a case of huge mucinous cystic tumor of the pancreas in a 26-year-old woman during pregnancy. Ultrasonography demonstrated a well-delimited cystic mass in the left upper abdominal quadrant, suggestive of benignity. Magnetic resonance imaging showed a large cystic mass resembling a mucinous cystic tumor of the pancreas. After this assessment the patient underwent surgical exploration and a huge cystic tumor of the pancreas was discovered. The tumor was enucleated and distal pancreatectomy was performed. The resected margin of the specimen was free of tumor. In this case report we discuss the management of mucinous pancreatic tumors during pregnancy and we briefly review the previously reported cases of mucinous pancreatic tumors in pregnant patients. We conclude that surgical resection of these tumors should be strongly considered in pregnancy. Removal of the tumor appears to be a safe procedure without harmful effects to the fetus.