Experiencia en el manejo quirúrgico del prolapso rectal mediante sutura helicoidal y anoplastia: estancia hospitalaria breve / Rectal prolapse: surgical experience with helicoidal suture and anoplasty: short hospital stay

BACKGROUND: We undertook this study to describe and analyze our experience with rectal prolapse treated by helicoidal suture and anoplasty at the Colorectal Service, Centro Médico Nacional, Adolfo Ruiz Cortines, Veracruz, México. METHODS: An ambispective study from 1999 to 2006 was performed in patients with rectal prolapse by chart review and outpatient clinic visit. All patients underwent helicoidal suture and anoplasty. RESULTS: Thirty two patients underwent surgery (12 males and 20 females). The mean age was 61.3 +/- 20.88 years (range: 21-94 years). History of rectal prolapse was from 1 month to 48 years. The most common symptoms were anal mass sensation, fecal incontinence, mucous discharge, rectal bleeding, chronic constipation and pain. Nineteen patients had a significant prior medical history and past surgical history. In-hospital stay was <24 h in 62.5% of procedures. There were no surgical complications. Two recurrences were documented and 28 patients had a minimum 12-month follow-up. To date, we have not documented any counter-referrals regarding complications or recurrences from primary care physicians. CONCLUSIONS: Helicoidal suture and anoplasty is an effective technique in rectal prolapse patients that offers certain advantages such as shorter in-hospital, rapid postoperative recovery, less surgical time and low recurrence rate.

[The burnout syndrome in medical residents working long periods]. / Síndrome de burnout en residentes con jornadas laborales prolongadas.

OBJECTIVE: to evaluate the burnout syndrome in medical residents with working periods longer than 80 hours per week. METHODOLOGY: an analytical cross-sectional study was conducted with medical residents working at Instituto Mexicano del Seguro Social hospital in Veracruz, México. The residents were classified in two groups. One group working for > or = 80 h per week (study group, SG) and another group working < 80 h per week (comparison group, CG) were studied. Participants were selected by simple random sampling. The clinical evaluation instrument was the scale of Maslach burnout inventory. RESULTS: 143 medical residents were included in the sample (SG n = 72, CG n = 71); the average age was 29.6 +/- 2.5 years, 65 % were males and 51 % were unmarried. Their length of service was 2.2 +/- 0.7 years. The mean working time was 100.5 +/- 7.2 hours per week for the SG and 64.4 +/- 9.3 hours for the CG. Burnout syndrome was present in 46 (63.8 %) medical residents with long workdays (p = 0.002); it was observed more frequently in those residents that were on call 3 times per week (p = 0.002) and among surgery residents (p = 0.035). CONCLUSION: working periods longer than 80 h per week are related to the appearance of burnout syndrome.

[Rectal prolapse. Surgical experience with helicoidal suture and anoplasty: short hospital stay]. / Experiencia en el manejo quirúrgico del prolapso rectal mediante sutura helicoidal y anoplastia: estancia hospitalaria breve.

BACKGROUND: We undertook this study to describe and analyze our experience with rectal prolapse treated by helicoidal suture and anoplasty at the Colorectal Service, Centro Médico Nacional, Adolfo Ruiz Cortines, Veracruz, México. METHODS: An ambispective study from 1999 to 2006 was performed in patients with rectal prolapse by chart review and outpatient clinic visit. All patients underwent helicoidal suture and anoplasty. RESULTS: Thirty two patients underwent surgery (12 males and 20 females). The mean age was 61.3 +/- 20.88 years (range: 21-94 years). History of rectal prolapse was from 1 month to 48 years. The most common symptoms were anal mass sensation, fecal incontinence, mucous discharge, rectal bleeding, chronic constipation and pain. Nineteen patients had a significant prior medical history and past surgical history. In-hospital stay was <24 h in 62.5% of procedures. There were no surgical complications. Two recurrences were documented and 28 patients had a minimum 12-month follow-up. To date, we have not documented any counter-referrals regarding complications or recurrences from primary care physicians. CONCLUSIONS: Helicoidal suture and anoplasty is an effective technique in rectal prolapse patients that offers certain advantages such as shorter in-hospital, rapid postoperative recovery, less surgical time and low recurrence rate.

[Exactness of transcutaneous sonography in the diagnosis of gastric wall lesions]. / Exactitud de la sonografía transcutánea en el diagnóstico de lesiones de pared gástrica.

OBJECTIVE: Our objective was to determine sensitivity, especificity and predictive values of transcutaneous sonography for detecting gastric wall lesions. MATERIALS AND METHODS: This prospective study was performed from March 1999 to April 2000 on 150 patients referred for transcutaneous sonography by the Endoscopic Service Unit. Sonographic examinations were performed using RT 4000 General Electric equipment with 5 Mhz transducer and replenishment of stomach with fluid. All scanning was done by the same sonographer, who was unaware of endoscopic, tomographic, or upper gastrointestinal series features. Results from sonography were compared with gastrointestinal tract endoscopy. Sensitivity, specificity, and predictive values were determined using contingency statistical procedure. Sonographic examination accuracy was calculated evaluating sensitivity and specificity confidence intervals (CI). Kappa index was calculated. Diagnostic accuracy differences observed between tumoral and non-tumoral lesions by sonography were evaluated by chi 2 probe. RESULTS: Sensitivity of 85% (95% CI, from 75.2 to 94.8%) and specificity of 90% (95% CI, from 86 to 93.9%) were obtained. Positive predictability was 78% and negative predictability was 94%. Diagnostic accuracy was 87%. Kappa index was 0.717. There were 35 no false-positive results (19 tumoral lesions and 16 non-tumoral lesions), seven false-negative results (one tumoral lesion and six non-tumoral lesions) and 10 false-positive results (two tumoral lesions and eight non-tumoral lesions). Only one of 20 tumoral lesions were diagnosed by ultrasound whereas from 22 non-tumoral lesions were not diagnosed 6 (chi 2 = 3.74, p > 0.05). CONCLUSION: Transcutaneous sonography is a rapid, low cost and non-invasive method that may be useful to establish clinic diagnosis and in the first steps of gastric wall lesions evaluation, it is valuable in assessment of diagnostic orientation for the referring clinic.

Exactitud de la biopsia por aspiración con aguja fina en el diagnóstico de nódulos tiroideos / Fine needle aspiration accuracy for thyroid nodules diagnosis

Objetivo. Determinar la exactitud de la BAAF en el diagnóstico de nódulos tiroideos. Diseño del estudio: Prueba diagnóstica. Métodos. Se realizó estudio prospectivo de febrero a octubre de 1998 y se incluyeron pacientes adultos, de cada sexo, a los que se les realizó biopsia por aspiración con aguja fina y cirugía de nódulos tiroideos; para cada procedimiento se firmó consentimiento informado; el proyecto fue aprobado por el comité local de investigación. Las muestras las analizó un patólogo experto en citología. El resultado de ambos estudios se comparó en cuanto a resultados positivos y negativos para cáncer de tiroides, y se analizó su sensibilidad, especificidad, exactitud diagnóstica, valor predictivo positivo y negativo. Resultados. Se estudió un total de 65 pacientes, 48 mujeres y 17 hombres, todos con nódulos tiroideos, hubo 29 pacientes con cáncer de tiroides y 36 sin él. La sensibilidad fue de 76 por ciento, especificidad 100 por ciento, exactitud 89.23 por ciento, valor predictivo positivo 83.72 por ciento y valor predictivo negativo 100 por ciento. Conclusiones. La BAAF tiene una buena exactitud diagnóstica (89 por ciento) y es más útil para descartar pacientes a quienes se sometieron a tratamiento quirúrgico

Aprendizaje en la residencia de cirugía / Learning at surgical education

Hipótesis. El avance técnico en la cirugía no va a la par con el avance en la técnica usada para su aprendizaje, por lo que algunos aspectos didácticos requieren ser analizados y reconsiderados. Objetivo. Analizar el proceso de aprendizaje en la residencia de cirugía. Método. Estudio prospectivo, octubre de 1996, encuesta anónima a médicos y residentes de cirugía general; 11 preguntas cerradas y 12 abiertas, análisis con estadística descriptiva y por categorías. Resultados. Se estudió 15 residentes (100 por ciento), cinco R2, cuatro R3 y seis R4, sexo masculino, edad 26 a 41 años, moda 28. Principales problemas durante la residencia: económico y falta de tiempo libre para estudiar y estar con la familiar. Factores que favorecen su aprendizaje: apoyo de los maestros, la cantidad de casos que atienden, la biblioteca, las clases. Factores que dificultan su aprendizaje: exceso de trabajo, falta de tiempo libre para descanso y estudio, medio hostil, falta de bibliografía disponible. Propuestas de soluciones: mayor organización de grupo, estudiar más, mejor organización integral del tiempo. Conclusiones. El aprendizaje en la residencia de cirugía se da principalmente a base de la enseñanza tutelar y la práctica clínica-quirúrgica; adolece de exceso de trabajo que resta tiempo para el descanso, el estudio y la vida familiar

Hernias incisionales operadas por cirujanos adscritos y residentes de cirugía / Incisional hernias operated by staff surgeons and by surgical residents

Las hernias incisionales operadas por médicos residentes presentan mayor morbilidad que las operadas por cirujanos adscritos. Con el objetivo de determinar si las hernias incicionales presentan más complicaciones en pacientes operados por médicos adscritos o por residentes de cirugía, se realizó un estudio prospectivo, comparativo, observacional y longitudinal, de enero a diciembre de 1996 en el servicio de cirugía. Se estudiaron pacientes consecutivos, adultos con hernia incisional, se excluyeron a aquellos que se presentaron complicaciones ajenas a la intervención quirúrgica. El proyecto se registró en el Comité local de investigación. Se formaron dos grupos: 1) con los pacientes operados por médicos adscritos, y 2) con los operados por médicos residentes. Se estudió la mortalidad y la morbilidad. Se realizó el análisis estadístico con EPIINFO, media, mediana, desviación estándar, Ji cuadrada, prueba exacta de Fisher y t de student. Se estudiaron 71 pacientes, no hubo diferencia significativa entre grupos en: edad, sexo, ocupación, medio socioeconómico, ASA, tiempo de aparición de la hernia, tiempo entre la cirugía previa y la actual, diagnóstico, tipo de puntos y material de sutura, tipo de malla usada y complicaciones. Hubo diferencia en peso (grupo 1: 74.5 Kg y grupo 2: 67.7 Kg), talla (grupo 1: 158 cm y grupo 2: 153 cm), tiempo operatorio (grupo 1: 91 min y grupo 2: 28 horas). Se concluyó que la plastía de pared abdominal por hernia incisional realizada por médicos residentes de cirugía se considera segura, no presenta mayor morbilidad que la realizada por cirujanos adscritos