Formación en cirugía general en España: troncalidad y áreas de capacitación específica / General surgery training in Spain: Core curriculum and specific areas of training

Se ha publicado el R.D. 639/2014 que regula la troncalidad y las áreas de capacitación específica (A.C.E.) que constituyen una norma de gran interés en la especialidad de Cirugía General y del Aparato Digestivo (C.G. y del A.D.)Se pretende exponer y concretar las principales disposiciones y reflexionar sobre sus implicaciones en la especialidad de C.G. y del A.D., para promover iniciativas y regulaciones. Después de una gestación compleja, este R.D. supondrá un hito en nuestra especialidad, que pondrá a prueba su fortaleza, si no es que culmina finalmente con su degradación frente a la emergencia de nuevas especialidades quirúrgicas, como ya sucedió en el pasado. Se inicia una etapa en la que la Asociación Española de Cirujanos deberá implicarse, para definir las bases conceptuales de la C.G. y del A.D. en el siglo XXI, y la creación de las nuevas A.C.E., para seguir manteniendo la «esencia de nuestra especialidad»

The royal decree RD 639/2014 has been published, regulating among others, the core curriculum, and specific areas of training (SAT). It is of great interest for the specialty of General and Digestive Surgery (GS and DS).The aim is to expose and clarify the main provisions and reflect on their implications for the practical application of the core curriculum and SAT in the specialty of General and Digestive Surgery, to promote initiatives and regulations. This RD will be a milestone in our specialty that will test the strength of the specialty, if it does not finally culminate in its degradation against the emergence of new surgical specialties. A new stage begins in which the Spanish Association of Surgeons should be involved to define the conceptual basis of GS and DS in the XXI century, and the creation of new SAT to continue to maintain the «essence of our specialty»

General surgery training in Spain: core curriculum and specific areas of training.

The royal decree RD 639/2014 has been published, regulating among others, the core curriculum, and specific areas of training (SAT). It is of great interest for the specialty of General and Digestive Surgery (GS and DS). The aim is to expose and clarify the main provisions and reflect on their implications for the practical application of the core curriculum and SAT in the specialty of General and Digestive Surgery, to promote initiatives and regulations. This RD will be a milestone in our specialty that will test the strength of the specialty, if it does not finally culminate in its degradation against the emergence of new surgical specialties. A new stage begins in which the Spanish Association of Surgeons should be involved to define the conceptual basis of GS and DS in the XXI century, and the creation of new SAT to continue to maintain the "essence of our specialty".

Hiperparatiroidismo primario y crisis hipercalcémica aguda tóxica / Primary hyperparathyroidism and acute toxic hypercalcaemic crisis

Objetivos: Describir las características clínicas y tratamiento quirúrgico de los pacientes con hipercalcemia aguda por hiperparatiroidismo primario (HPTP) y compararlas con las de otros pacientes con HPTP sin hipercalcemia aguda asociada. Material y métodos Estudio observacional prospectivo (1998-2010) sobre 158 pacientes con HPTP tratados mediante paratiroidectomía. Se identificaron aquellos con hipercalcemia aguda (>14mg/dl-3,5mmol/l- o >3mmol/l con síntomas de calciotoxicosis), se evaluaron sus características clínicas y terapéuticas y se compararon, mediante la U de Mann-Whitney y el test de Fisher, con los 146 pacientes con HPTP sin crisis hipercalcémicas. Resultados Doce pacientes (7,6%) presentaron hipercalcemia aguda con síntomas de calciotoxicosis y otros síntomas de cronicidad. Los valores preoperatorios de calcemia y PTH fueron 14,5±1,3mg/dl y 648,2±542pg/dl, respectivamente. Hubo 10 adenomas, una hiperplasia y un carcinoma. El peso medio de las piezas quirúrgicas fue 4.075±2.918 mg con un diámetro mayor de 27±14mm. Los gradientes de caída de PTH a los 10 y 25min fueron 79±18% y 92±6%. Las calcemias postoperatorias al alta y a los 6 meses fueron 8,2±0,7 y 9,1±0,9mg/dl. Las concentraciones plasmáticas de Ca, PTH y el peso y tamaño de las piezas quirúrgicas fueron mayores en los pacientes con crisis hipercalcémicas (p<0,001). No hubo diferencias en otros parámetros estudiados y en la tasa de curación. Conclusiones Las crisis hipercalcémicas fueron producidas por tumores más grandes, de mayor peso y que producían mayores concentraciones plasmáticas de Ca y PTH. Todos los pacientes presentaban síntomas de evolución crónica y la paratiroidectomía consiguió la curación (AU)

Objectives: To describe the clinical characteristics and surgical treatment of patients with acute hypercalcaemia due to primary hyperparathyroidism (PHPT) and compare them with other patients with PHPT without associated acute hypercalcaemia. Material and methods: A prospective, observational study (1998-2010) was conducted on 158patients with PHPT treated by parathyroidectomy. Those with acute hypercalcaemia(>14 mg/dl -3.5 mmol/L- or >3 mmol/L with symptoms of calcium toxicity) were evaluated by recording their clinical and treatment characteristics, and comparing them, using the Mann-Whitney U test and the Fisher test, with the 146 PHPT patients without hypercalcaemic crisis. Results: Twelve patients (7.6%) had acute hypercalcaemia with symptoms of calcium toxicity and other symptoms of chronicity. The preoperative calcium and PTH values were14.5 1.3 mg/dL and 648.2 542 pg/dL, respectively. There were 10 adenomas, 1 hyperplasia and 1 carcinoma. The mean weight of the surgical pieces was 4.075 2.918 mg, with a diameter greater than 27 14 mm. The gradients of PTH at 10 and 25 minutes were 79 18%and 92 6%, respectively. Post-operative calcium values on discharge and at 6 months were8.2 0.7 mg/dL and 9.1 0.9 mg/dL, respectively. The plasma concentrations of calcium, PTH, and the size of the surgical pieces were higher in patients with hypercalcaemic crisis(P<0.001). There were no differences in the other parameters studied or in the cure rate. Conclusions: Hypercalcaemic crises were caused by larger and heavier tumours that led to higher plasma Ca and PTH plasma concentrations. All patients had long-standing symptoms and parathyroidectomy led to cure of the disease (AU)

[Primary hyperparathyroidism and acute toxic hypercalcaemic crisis]. / Hiperparatiroidismo primario y crisis hipercalcémica aguda tóxica.

OBJECTIVES: To describe the clinical characteristics and surgical treatment of patients with acute hypercalcaemia due to primary hyperparathyroidism (PHPT) and compare them with other patients with PHPT without associated acute hypercalcaemia. MATERIAL AND METHODS: A prospective, observational study (1998-2010) was conducted on 158 patients with PHPT treated by parathyroidectomy. Those with acute hypercalcaemia (>14 mg/dl -3.5 mmol/L- or >3 mmol/L with symptoms of calcium toxicity) were evaluated by recording their clinical and treatment characteristics, and comparing them, using the Mann-Whitney U test and the Fisher test, with the 146 PHPT patients without hypercalcaemic crisis. RESULTS: Twelve patients (7.6%) had acute hypercalcaemia with symptoms of calcium toxicity and other symptoms of chronicity. The preoperative calcium and PTH values were 14.5 ± 1.3mg/dL and 648.2 ± 542 pg/dL, respectively. There were 10 adenomas, 1 hyperplasia and 1 carcinoma. The mean weight of the surgical pieces was 4.075 ± 2.918 mg, with a diameter greater than 27 ± 14 mm. The gradients of PTH at 10 and 25 minutes were 79 ± 18% and 92 ± 6%, respectively. Post-operative calcium values on discharge and at 6 months were 8.2 ± 0.7 mg/dL and 9.1 ± 0.9 mg/dL, respectively. The plasma concentrations of calcium, PTH, and the size of the surgical pieces were higher in patients with hypercalcaemic crisis (P<0.001). There were no differences in the other parameters studied or in the cure rate. CONCLUSIONS: Hypercalcaemic crises were caused by larger and heavier tumours that led to higher plasma Ca and PTH plasma concentrations. All patients had long-standing symptoms and parathyroidectomy led to cure of the disease.

[Surgical training in Spain: results of a national survey]. / Formación quirúrgica en España: resultados de una encuesta nacional.

INTRODUCTION: The aim of the study is to try and find out the state of surgical training in Spain and to determine whether it meets the objectives of the Program. MATERIAL AND METHODS: The results of two surveys carried out on Residents and General Surgery Tutors by the Spanish Surgeons Association, based on the conclusions of the XXVII Congreso Nacional de Cirugía. The questions formulated referred to general aspects of the Service and specific ones related to access, teaching activity, surgery, research and personal perspectives. The responses were defined, adjusted and categorised as quantitative and qualitative variables. The statistics program G Stat 2.0 was used for processing and the descriptive presentation of the results. RESULTS: The surveys were sent to 626 Residents and 142 Tutors, with a response rate of 19% and 29%, respectively. First year residents predominated (32%) compared to later years, with an R-5 response index of 7.2%. A total of 91% knew the speciality Program well, and 76% were satisfied with the training received. CONCLUSIONS: The results obtained as regards surgical activity agree with those established in the Program, both in the number of procedures and in their progression throughout the Residency, although it is not possible to ensure its uniformity. The functions and accreditation of the Tutors which are one of the main foundations of the training process are pending specific regulations.