Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure: a cohort study.

BACKGROUND: The aim of this study is to evaluate morbidity and mortality in patients taken to conversion to open procedure (CO) and subtotal laparoscopic cholecystectomy (SLC) as bailout procedures when performing difficult laparoscopic cholecystectomy. METHOD: This observational cohort study retrospectively analyzed patients taken to SLC or CO as bailout surgery during difficult laparoscopic cholecystectomy between 2014 and 2022. Univariable and multivariable logistic regression models were used to identify prognostic factors for morbimortality. RESULTS: A total of 675 patients were included. Of the 675 patients (mean [SD] age 63.85 ± 16.00 years; 390 [57.7%] male) included in the analysis, 452 (67%) underwent CO and 223 (33%) underwent SLC. Overall, neither procedure had an increased risk of major complications (89 [19.69%] vs 35 [15.69%] P.207). However, CO had an increased risk of bile duct injury (18 [3.98] vs 1 [0.44] P.009), bleeding (mean [SD] 165.43 ± 368.57 vs 43.25 ± 123.42 P < .001), intestinal injury (20 [4.42%] vs 0 [0.00] P.001), and wound infection (18 [3.98%] vs 2 [0.89%] P.026), while SLC had a higher risk of bile leak (15 [3.31] vs 16 [7.17] P.024). On the multivariable analysis, Charlson comorbidity index (odds ratio [OR], 1.20; CI95%, 1.01-1.42), use of anticoagulant agents (OR, 2.56; CI95%, 1.21-5.44), classification of severity of cholecystitis grade III (OR, 2.96; CI95%, 1.48-5.94), and emergency admission (OR, 6.07; CI95%, 1.33-27.74) were associated with presenting major complications. CONCLUSIONS: SLC was less associated with complications; however, there is scant evidence on its long-term outcomes. Further research is needed on SLC to establish if it is the safest in the long-term as a bailout procedure.

Postoperative pain in transabdominal preperitoneal laparoscopic hernia repair with staple fixation versus self-fixation mesh.

Background: The mesh fixation method is one of the multiple factors associated with chronic postoperative pain in inguinal hernia surgery. The aim of this study is to evaluate postoperative pain associated with the two available fixation strategies (staple fixation versus self-fixating mesh) used in our field. Methods: We designed an observational study with retrospective cohorts to analyze postoperative pain in patients who underwent a laparoscopic transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh or staple fixation, which are the two available techniques in our field. A total of 296 patients who met the inclusion criteria were included between January 2014 and October 2021. Results: The evaluated patients' median age was 66.0 (interquartile range (IQR): 20.75) years and were predominantly male (70.13 %). The proportion of participants with chronic pain was 3.20 % in the staple fixation group and 0 % in the self-fixating mesh group, with no statistically significant differences. On the other hand, recurrency in the staple fixation group was 2.28 % versus 3.90 % in the self-fixating mesh group, without statistically significant differences. Conclusions: Self-fixating meshes have a trend towards smaller proportion of chronic pain and similar proportions of recurrence; therefore, they seem to be the best fixation method between the two mechanisms that are available in our field to prevent postoperative chronic pain.

Timing of CHolecystectomy In Severe PAncreatitis (CHISPA): study protocol for a randomized controlled trial.

Acute pancreatitis is the recurrent reason for gastrointestinal admission in a clinical urgent setting, it happens secondary to a wide array of pathologies out of which biliary disease stands as one of the most frequent causes for its presentation. Approximately 20% of pancreatitis are of moderate or severe severity. Currently, there is not a clear recommendation on timing for cholecystectomy, either early or delayed. CHISPA is a randomized controlled, parallel-group, superior clinical trial. An intention-to-treat analysis will be performed. It seeks to evaluate differences between patients taken to early cholecystectomy during hospital admission (72 hours after randomization) versus delayed cholecystectomy (30±5 days after randomization). The primary endpoint is major complications associated with laparoscopic cholecystectomy defined as a Clavien-Dindo score of over III/V during the first 90 days after the procedure. Secondary endpoints include recurrence of biliary disease, minor complications (Clavien-Dindo score below III/V), days of postoperative hospital stay, and length of stay in an intensive therapy unit postoperatively (if it applies). The CHISPA trial has been designed to demonstrate that delayed laparoscopic cholecystectomy reduces the rate of complications associated to an episode of severe biliary pancreatitis compared to early laparoscopic cholecystectomy.Trial registration number: NCT06113419.

Retrospective analysis of 261 autopsies of penetrating cardiac injuries with emphasis on sociodemographic factors.

Penetrating cardiac injuries (PCIs) are highly lethal and several factors are related to its incidence and mortality. While most studies focus on characterizing patients who arrived at a medical facility alive and exploring the relationship between the degree of heart compromise and mortality, our study delved deeper into the topic. This study analyzed 261 autopsy reports from 2017 in Bogotá, Colombia, and characterized the factors surrounding PCI incidence and mortality while emphasizing the role of sociodemographic variables. Of these cases, 247 (94.6%) were males with a mean age of 29.19 ± 9.7 years. Weekends, holidays, and late hours had the highest incidence of PCIs. The victims' deaths occurred at the scene in 66 (25.3%) cases, and 65.1% of the victims died before receiving medical care. Upon admission, patients with vital signs were more likely to have been transported by taxi or a private vehicle. Two or more compromised cardiac chambers, increased time of transportation, trauma occurred in the city outskirts, and gunshot wounds were related to increased mortality. Our data is valuable for surgeons, health system managers, and policy analysts as we conducted a holistic assessment of the anatomical and sociodemographic factors that are closely associated with mortality following a PCI. Surgeons must recognize that PCIs can occur even when the entrance wound is outside the cardiac box. Reinforcing hospital infrastructure in the outskirts and improving the availability, accuracy, and response time of first responders may lead to improved patient mortality rates.

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute calculous cholecystitis in patients over 90 years of age.

BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard of care for acute calculous cholecystitis; however, in patients at high risk for surgery, particularly in the elderly, insertion of a percutaneous catheter drainage (PCD) at gallbladder is recommended. Current evidence suggests that PCD may have less favorable outcomes than LC, but also that LC-associated complications increase in direct relation to patient age. There is no recommendation supported by robust evidence to decide between one or the other procedure in super elderly patients. METHODS: A retrospective observational cohort study was designed to analyze the surgical outcomes of super elderly patients with cholecystitis who underwent LC versus PCD for treatment. The surgical outcomes of a subgroup of high-risk patients were also analyzed. RESULTS: A total of 96 patients who met the inclusion criteria between 2014 and 2021 were included. The median age of patients were 92 years (IQR: 4.00) with a female predominance (58.33%). The overall morbidity rate in the series was 36.45% and mortality rate was 7.29%. There was no statistically significant difference when compared to the associated morbidity and mortality among patients who underwent LC versus those who underwent PCD, neither in the analysis of the complete series or in the subgroup of high-risk patients. CONCLUSIONS: The morbidity and mortality associated with the two most frequently recommended therapeutic options for operating super elderly patients with acute cholecystitis are high. We found no evidence of superiority in outcomes for either of the two procedures in this age group.

Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes.

BACKGROUND: Nonagenarian patients are an age group in progressive growth. In this age group, indications for surgical procedures, including cholecystectomy, will be increasingly frequent, as biliary pathology and its complications are frequent in this population group. The main objective of this study was to analyze the safety and outcomes of laparoscopic cholecystectomy in patients older than 90 years. METHODS: A retrospective observational cohort study was designed. This study involved 600 patients that were classified in 4 age groups for analysis (under 50 years, 50-69 years, 70-89 years, and over 90 years). Demographic, clinical, paraclinics, surgical, and outcome variables were compared according to age group. A multivariate analysis, which included variables considered clinically relevant, was performed to identify factors associated with mortality and complications classified with the Clavien-Dindo scale. RESULTS: The patients evaluated had a median age of 65.0 (IQR 34.0) years and there was a female predominance (61.8%). A higher complication rate, conversion rate, subtotal cholecystectomy rate, and prolonged hospital stay were found in nonagenarians. The overall mortality rate was 1.6%. Mortality in the age group over 90 years was 6.8%. Regression models showed that age over 90 years (RR 4.6 CI95% 1.07-20.13), presence of cholecystitis (RR 8.2 CI95% 1.29-51.81), and time from admission to cholecystectomy (RR 1.2 CI95% 1.10-1.40) were the variables that presented statistically significant differences as risk factors for mortality. CONCLUSION: Cholecystectomy in nonagenarian patients has a higher rate of complications, conversion rate, subtotal cholecystectomy rate, and mortality. Therefore, an adequate perioperative assessment is necessary to optimize comorbidities and improve outcomes. Also, it is important to know the greatest risk for informed consent and choose the surgical equipment and schedule of the procedure.

Survival Outcomes of Hepatectomy in Gastric Cancer Liver Metastasis: A Systematic Review and Meta-Analysis.

Gastric cancer liver metastasis (GCLM) is a contraindication for surgical treatment in current guidelines. However, the results of recent studies are questioning this paradigm. We assessed survival outcomes and their predictors following hepatectomy for GCLM in a systematic review of studies published from 2000 to 2022 according to PRISMA guidelines. We identified 42,160 references in four databases. Of these, 55 articles providing data from 1990 patients fulfilled our criteria and were included. We performed a meta-analysis using random-effects models to assess overall survival (OS) and disease-free survival (DFS) at one, three, and five years post-surgery. We studied the impact of potential prognostic factors on survival outcomes via meta-regression. One, three, and five years after surgery, OS was 69.79%, 34.79%, and 24.68%, whereas DFS was 41.39%, 23.23%, and 20.18%, respectively. Metachronous presentation, well-to-moderate differentiation, small hepatic tumoral size, early nodal stage, R0 resection, unilobar compromisation, and solitary lesions were associated with higher overall survival. Metachronous presentation, smaller primary tumoral size, and solitary metastasis were linked to longer DFS. The results of our meta-analysis suggest that hepatectomy leads to favorable survival outcomes in patients with GCLM and provides data that might help select patients who will benefit most from surgical treatment.

Surgical mortality in patients in extremis: futility in emergency abdominal surgery.

BACKGROUND: The number of older patients with multiple comorbidities in the emergency service is increasingly frequent, which implies the risk of incurring in futile surgical interventions. Some interventions generate false expectations of survival or quality of life in patients and families and represent a negligible therapeutic benefit in patients whose chances of survival are minimal. In order to address this dilemma, we describe mortality in a cohort of patients undergoing emergency laparotomy with a risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. METHODS: A retrospective observational study was designed to analyze postoperative mortality and factors associated with postoperative mortality in a cohort of patients undergoing emergency laparotomy between January 2018 and December 2021 in a high-complexity hospital who had a mortality risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. RESULTS: A total of 890 emergency laparotomies were performed during the study period, and 50 patients were included for the analysis. Patient median age was 82.5 (IQR: 18.25) years old and 33 (66.00%) were male. The most frequent diagnoses were mesenteric ischemia 21 (42%) and secondary peritonitis 18 (36%). Mortality in the series was 92%. Twenty-four (54.34%) died within the first 24 h of the postoperative period; 11 (23.91%) within 72 h and 10 (21.73%) within 30 days. APACHE II and SOFA scores were statistically significantly higher in patients who died. CONCLUSIONS: All available tools should be used to make decisions, with the most reliable and objective information possible, and be particularly vigilant in patients at extreme risk (mortality risk greater than 75% according to ACS NSQIP Surgical Risk Calculator) to avoid futility and its consequences. The available information should be shared with the patient, the family, or their guardians through an assertive and empathetic communication strategy. It is necessary to insist on a culture of surgical ethics based on reflection and continuous improvement in patient care and to know how to accompany them in order to have a proper death.

Succoring the challenging acute mesenteric ischemia: Feasibility of lactate dehydrogenase for evaluation of intestinal necrosis extension and mortality.

Background: Acute mesenteric ischemia is a lethal challenging pathology for surgeons in the emergency department due to its ambiguous clinical presentation and lack of early diagnostic markers. Serum lactate is considered a relevant biomarker in terms of bowel necrosis length and mortality prediction. Nevertheless, its association has been poorly studied. Hence, we evaluated the relation between serum lactate admission levels, bowel necrosis extension, and mortality in patients with acute mesenteric ischemia. Methods: A Retrospective cross-sectional study with a prospective database was conducted, including patients over 18 years old with mesenteric ischemia that required surgical management between January 2012 and December 2018. We describe the association between serum lactate admission levels with bowel necrosis length and mortality in patients with acute mesenteric ischemia. Results: 74 patients presented with acute mesenteric ischemia, 44 males and 30 females. Mean age was 73.5 ± 10.7 years old. Significant association between serum lactate admission levels and mortality was found (ROC cut-value of 3.8 mmol/l, 81.0% sensibility and 76% specificity, LR+3.41 (95%CI 1.57, 7.40), LR- 0.25 (95%CI 0.13-0.45))(P.001). Nonetheless no statistically significant association was found between serum lactate admission levels and bowel necrosis length (ρ = 0.195,95%CI -0.046, -0.436, P > .99). As post hoc analysis, a classification and regression tree on mortality was fitted. Conclusions: Early diagnosis, prognosis and management of mesenteric ischemia is vital given its high morbidity and mortality. Serum lactate admission levels can be considered as a useful prognostic tool in terms of mortality in patients with acute mesenteric ischemia.

Predicting the difficult laparoscopic cholecystectomy based on a preoperative scale.

It is important to establish the difficulty of a cholecystectomy preoperatively to improve the outcomes. There are multiple risk factors for a difficult cholecystectomy that may depend on the patient, the disease, or extrinsic factors. The aim of this study is to evaluate the predictive capacity of a difficult cholecystectomy with a preoperative scale. A diagnostic trial study was designed to evaluate the performance of a scale to predict the difficulty of laparoscopic cholecystectomy, considering as a reference standard the intraoperative findings evaluated according to an intraoperative difficulty scale. A ROC curve was performed and used to estimate predictive value of the preoperative score to predict the difficulty of a cholecystectomy preoperatively. The ROC curve shows an area of 0.88 under the curve. The calculated ideal cutoff was 8, with a sensitivity, specificity, positive predictive value and negative predictive value of 75.15%, 88.31%, 87.32 and 76.83%, respectively. It was demonstrated that, as the difficulty predicted by the preoperative scale increases, the rate of conversion to open procedure, the rate of subtotal cholecystectomies, the rate of complication and the rate of a critical view of safety failed increase. We suggest implementing the preoperative scale in all patients who are planning laparoscopic cholecystectomy, considering it a simple and easy tool to perform. This to inform the patient, organize the surgery schedule, select personnel, request support and have adequate pre-operative planning.

Surgical Rescue in a High-volume Urban Emergency General Surgery Service at a Middle-income Country.

Introduction: The capacity for prompt "rescue" from death in patients with complications has become an important marker of the quality of care since mortality and morbidity have been identified as incongruous indicators. This study aims to describe the incidence of "surgical rescue" failure and the outcomes of emergency general surgery (EGS) patients at a large academic medical center. Materials and methods: In our high-volume surgical hospital, an electronic EGS registry was developed to automatically capture in-hospital information and outcomes from the Electronic Medical Record (EMR). Surgical complications were included in an online application and automatically captured in the electronic EGS registry, and prospectively screened from June to July 2017 for acute EGS surgical patients from operative procedures. Results: A total of 501 patients (average age: 53.9 ± 20.9, 56.5% female) underwent 882 EGS procedures. Thirteen patients (2.6%) of the 501 patients required "surgical rescue", mainly for uncontrolled sepsis (43%) and anastomotic leakage (30%). The surgical rescue failure rate (inability to prevent death after a surgical complication) was 15.4%. Patients requiring critical care (OR = 3.3, IC 95%: 1.04, 10.5), hospital admission (p = 0.038), and hospital LOS (days) (p = 0.004) were significantly higher for the surgical rescue patients than for those without complications. Conclusion: Surgical failure to rescue rate was similar among high-volume EGS services, as has recently been described in the United States. The latest development and implementation of an electronic automatic captured EGS registry database in our academic medical center will serve to build best practices for "surgical rescue" and drive quality improvement programs.

Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test.

BACKGROUND: There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. METHODS: We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. RESULTS: The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered "asymptomatic" as they didn't present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5-99.5%] and 98.7% [CI] [92.8-99.8%] respectively, with a range of confidence [CI] of 95%. CONCLUSIONS: Our study's main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.

The Peritoneum: Beyond the Tissue - A Review.

Background: Despite its complexity, the peritoneum is usually underestimated in classical medical texts simply as the surrounding tissue (serous membrane) of the gut. Novel findings on physiology and morphology of the peritoneum and mesothelial cell exist but they are usually focused or limited to Continuous Ambulatory Peritoneal Dialysis research and practice. This review aims to expose, describe and analyze the most recent evidence on the peritoneum's morphology, embryology and physiology. Materials and Methods: A literature review was performed on Pubmed and MEDLINE. With no limit of publication date, original papers and literature reviews about the peritoneum, the peritoneal cavity, peritoneal fluid, and mesothelial cells were included (n = 72). Results: Peritoneum develops in close relationship to the gut from an early period in embryogenesis. Analyzing together the development of the primitive gut and the surrounding mesothelium helps understanding that the peritoneal cavity, the mesenteries and other structures can be considered parts of the peritoneum. However, some authors consider that structures like the mesenteries are different to the peritoneum. The mesothelial cell has a complex ultrastructural organization with intercellular junctions and apical microvilli. This complexity is further proven by the large array of functions like selective fluid and cell transport; physiological protective barrier; immune induction, modulation, and inhibition; tissue repair and scarring; preventing adhesion and tumoral dissemination; cellular migration; and the epithelial-mesenchymal transition capacity. Conclusion: Recent evidence on the anatomy, histology, and physiology of the peritoneum, shows that this structure is more complex than a simple serous membrane. These results call for a new conceptualization of peritoneum, and highlight the need of adequate research for identifying clinical relevance of this knowledge.

The influence of different curriculum designs on students' dropout rate: a case study.

The relationship between students' withdrawal and educational variables has generated a considerable number of publications. As the explosion of information in sciences and integration theories led to creating different curriculum designs, it has been assumed that differences among designs explain academic success and, therefore, students' retention. However, little attention has been given to examine explicitly how diverse designs influence dropout rates in practice, which questions if decisions to reform curricula are sufficiently informed. This article describes our curriculum reform, which exposes our former and current curriculum designs as having had dissimilar dropout percentages. Furthermore, we aimed to explore the influence of different curriculum designs on students' dropout rates. The conclusion is that dropout variations may be explained not only because of the curriculum design itself, but also because of the power relationship changes between teachers and students that brought out the design change. Consequently, more research is needed to fully understand the political implications of different curriculum designs and their influence on dropout rates.

Vólvulo en el embarazo: reporte de un caso / Volvulus in pregnancy: a case report / Volvulus na gravidez: relato de caso

El vólvulo del colon es la causa más común de obstrucción intestinal durante la gestación, y representa una causa importante de morbimortalidad materna y fetal. Su diagnóstico clínico es difícil, debido a que el embarazo dificulta la adecuada identificación de signos y de síntomas. Ello explica que las imágenes diagnósticas sean indispensables como herramienta confirmatoria. La instauración de un rápido tratamiento es esencial para los pronósticos materno y fetal. Se presenta el caso clínico de una mujer de 33 años en el último mes de su gestación, y quien ingresa a un hospital de tercer nivel en la ciudad de Bogotá, Colombia, por un cuadro clínico sugestivo de obstrucción intestinal. La Resonancia Nuclear Magnética (RNM) evidencia signos radiológicos sugestivos de vólvulo, por lo cual se decide realizar laparotomía de urgencia, que confirma vólvulo del sigmoide sin necrosis. Se devolvula manualmente y se fija a la gotera parietocólica, como medida transitoria, para posterior sigmoidectomía, como tratamiento definitivo. Se analiza el caso a la luz de la literatura científica disponible. El objetivo de este trabajo es familiarizar al personal de la salud con este cuadro clínico, para garantizar una rápida instauración del tratamiento, con el fin de evitar las complicaciones que se pueden desencadenar en quienes lo padecen.

Colonic volvulus is the most common cause of bowel obstruction during gestation and is an important cause of maternal and fetal morbidity and mortality. Its clinical diagnosis is challenging because pregnancy hinder an adequate identification of signs and symptoms. This explains why diagnostic imaging is currently considered as the gold-standard for diagnosis. Placement on effective therapy is essential to ensure adequate maternal and fetal prognosis. We present the case of a 33-year-old woman in the last month of pregnancy, who was admitted into a third-level hospital in Bogotá, Colombia. She had a clinical scenario consistent with intestinal obstruction. Magnetic Nuclear Resonance (MRI) shows radiological findings suggestive of volvulus, so emergency laparotomy was performed. Non-necrotic sigmoid volvulus was confirmed. It was manually corrected and fixed to the parietal-like leak as a transient measure for subsequent sigmoidectomy as a definitive treatment. We present a review of the literature available in electronic databases and a critical analysis of the case management. The objective of this study is to familiarize health personnel with this clinical scenario, in order to ensure efficient treatment strategies and avoid common and potentially lethal complications

Vólvulo do cólon é a mais comum causa de obstruçãointestinal durante a gestaçãoe representa das principaiscausas de mortalidade e morbidade materna e fetal.diagnóstico clínico é difícil, porque a gravidez dificulta aidentificação adequada dos sinais e síntomas ou vólvulo de colon é para causar comum de mais de obstrução intestinal durante para gestação e representa uma que causa importante de morbimortalidad materno e fetal. Diagnosticar deles / delas clínico é difícil porque para gravidez impeça a apropriada de sinais de identificação e síntomas a ressonância magnética (RNM) nuclear comprova sinais sugestivos radiológicos de vólvulo para o que decide levar a cabo laparotomía de urgência que confirma vólvulo do sigmoide sem necrose. você devolvula manualmente e ele/ela nota ao parietocólica de vazamento goste de medida transitória para sigmoidectomía posterior goste de tratamento definitivo. Discutte o caso a luz da literatura científica disponivel objetivo deste trabalho é tornarse familiarizado com estepessoal saúde queadro clínico para asegurar um rápido establecimento do tratamento, a fin de evitar acomplições que podem ser acionadas em pessoas quesofrem com isso

Low values of central venous oxygen saturation (ScvO2) during surgery and anastomotic leak of abdominal trauma patients.

BACKGROUND: There is a well known relationship between hypoperfusion and postoperative complications like anastomotic leak. No studies have been done addressing this relationship in the context of abdominal trauma surgery. Central venous oxygen saturation is an important hypoperfusion marker of potential use in abdominal trauma surgery for identifying the risk of anastomotic leak development. The purpose of this study was to identify the relationship between low values of central venous oxygen saturation and anastomotic leak of gastrointestinal sutures in the postoperative period in abdominal trauma surgery. METHODS: A cross-sectional prospective study was performed. Patients over 14 years old who required surgical gastrointestinal repair secondary to abdominal trauma were included. Anastomotic leak diagnosis was confirmed through clinical manifestations and diagnostic images or secondary surgery when needed. Central venous oxygen blood saturation was measured at the beginning of surgery through a central catheter. Demographic data, trauma mechanism, anatomic site of trauma, hemoglobin levels, abdominal trauma index, and comorbidities were assessed as secondary variables. RESULTS: Patients who developed anastomotic leak showed lower mean central venous oxygen saturation levels (60.0% ± 2.94%) than those who did not (69.89% ± 7.21%) (p = 0.010). CONCLUSIONS: Central venous oxygen saturation <65% was associated with the development of gastrointestinal leak during postoperative time of patients who underwent surgery secondary to abdominal trauma.

Penetrating cardiac trauma: analysis of 240 cases from a hospital in Bogota, Colombia.

BACKGROUND: Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. METHODS: This is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed. RESULTS: The study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120). CONCLUSIONS: The study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach.

Experiencia en el manejo de cáncer colorrectal en Méderi-Hospital Universitario Mayor, 2012-2014 / Experience with the management of colorectal cancer at Mederi Major University Hospital, Bogotá, Colombia 2012-2014

Introducción. El cáncer colorrectal es el tercer cáncer más diagnosticado a nivel mundial en hombres y el segundo en mujeres. En Colombia, es la cuarta causa de muerte por cáncer en ambos sexos. Es importante conocer las características de su presentación clínica en nuestro medio y la experiencia en el manejo de esta neoplasia en instituciones hospitalarias de Colombia que sirvan como referencia para analizar tendencias y resultados. Materiales y métodos. Se llevó a cabo un estudio de corte transversal de la población con diagnóstico de cáncer colorrectal atendida entre agosto de 2012 y diciembre de 2014, que corresponde al periodo de funcionamiento del Servicio de Coloproctología de Méderi-Hospital Universitario Mayor. Resultados. Se atendieron 152 pacientes, 57 % (n=87) eran mujeres. La edad promedio fue de 67 años. Se intervino quirúrgicamente el 91 % (n=138), el 61 % (n=93) por vía laparoscópica y el 25 % (n=38) se encontraron en estadio IV. Solo el 4,6 % (n=7) presentó dehiscencia de la anastomosis. El subtipo histológico más frecuente fue el adenocarcinoma moderadamente diferenciado. Discusión. Las características demográficas de la serie coinciden con las reportadas en la literatura científica. Como sucede en países similares al nuestro, esta neoplasia se diagnostica en los estadios avanzados, lo que sugiere deficiencia del sistema de tamización y diagnóstico precoz. Los resultados del manejo son similares a los reportados por otros grupos de excelencia

Introduction: Colorectal cancer is the third most diagnosed cancer in men and the second in women worldwide. In Colombia, it is the fourth leading cause of cancer death in both sexes. It is important to know the characteristics of its clinical presentation in our environment and the experience in the management of this pathology in hospital institutions in Colombia that serve as reference to analyze trends and results. Methods: A cross-sectional study of the population with the diagnosis of colorectal cancer was performed between August 2012 and December 2014, which corresponds to the period of operation of the Department of Coloproctology of Méderi-Hospital Universitario Mayor. Results: A total of 152 patients were attended, 57% (n = 87) women. The average age was 67 years. 91% (n = 138) were surgically intervened, 61% (n = 93) by laparoscopy and 25% (n = 38) were found in stage IV. Only 4.6% (n = 7) had anastomotic dehiscence. The most frequent histological subtype was moderately differentiated adenocarcinoma. Discussion: The demographic characteristics of the series coincide with those reported in the literature. As in countries similar to ours, this pathology is diagnosed in advanced stages, suggesting deficiency of screening and early diagnosis in the health system. The results of the management are similar to those reported by other groups of excellence

Deserción y rezago académico en el programa de medicina de la Universidad del Rosario, Bogotá, Colombia / Dropout and Graduation Delay in Undergraduate Medical Students. Universidad del Rosario, Bogotá, Colombia / Deserção e atraso acadêmico no curso de medicina da Universidad del Rosario, Bogota, Colômbia

Introducción: el abandono y rezago en los programas de educación superior en Colombia y el mundo constituyen un problema de gran magnitud que afecta alrededor del 50% de estudiantes y conlleva un alto impacto personal, social y económico. Materiales y métodos: describir las características de la deserción estudiantil en el programa de medicina de la Universidad del Rosario y las variables asociadas. Se realizó un estudio descriptivo retrospectivo de las cohortes que ingresaron en los dos periodos académicos de 2003 y de la información académica de las cohortes de estudiantes registrados en el programa entre los años 2003 y 2008. Los datos se analizaron desde las perspectivas longitudinal y transversal. Resultados: la desvinculación definitiva total en las cohortes que ingresaron en los dos periodos académicos de 2003 fue de 47% y 36%, la desvinculación temporal fue de 29% y 36%, y obtuvieron el grado en el tiempo previsto el 22% y 19% de los estudiantes, respectivamente. La desvinculación promedio en cada periodo académico entre 2003 y 2008 fue 7,1%. La principal explicación para la deserción fue de índole académica. Discusión: los porcentajes de deserción y el rezago académico en el currículo tradicional de medicina entre 2003 y 2008 fueron altos, similares a los de la educación superior en Colombia. Entre la complejidad que caracteriza este fenómeno, las estrategias pedagógicas y los aspectos académicos y curriculares parecen desempeñar un papel preponderante. Esta cohorte histórica y sus indicadores de deserción servirán de base de comparación para el nuevo currículo del programa de Medicina recientemente instaurado.

Introduction: Dropout and graduation delay in higher education programs are a major problem worldwide, therefore also in Colombia, where it affects about 50% of the students, a fact that produces a high personal, social and economic impact. Objective: To describe the characteristics of the dropout and graduation delay of Medical School students at the El Rosario University, and its associated variables. Materials and methods: A retrospective, descriptive study of the two cohorts admitted in 2003 and of the academic information of students enrolled during the years 2003 through 2008 was performed. Data were analyzed from longitudinal and transversal perspectives. Results: Longitudinal analysis showed that both cohorts admitted in 2003 had a dropout rate of 47% and 36%, graduation delay of 29% and 36%; and 22% and 19% of the students, respectively, obtained their degree in the expected time. The mean dropout per academic period between 2003 and 2008 was 7.1%. The main reazon for dropout was academic failure. Discussion: The dropout and graduation delay rates in the traditional curriculum of the Medical School between 2003 and 2008 were high, similar to those found in higher education in Colombia. Among the complexity that characterizes this phenomenon, teaching strategies and academic and curricular aspects seem to play a major role. This historical cohort and the associated dropout indicators will serve as a basis for comparison for the new curriculum of the Medical School program recently established.

Introdução: O abandono e atraso nos cursos de educação superior na Colômbia e no mundo constituem um problema de grande magnitude que afeta cerca do 50% de estudantes e leva um alto impacto pessoal, social e económico. Materiais e métodos: Descrever as características da deserção estudantil no curso de medicina da Universidad del Rosario e as variáveis associadas ao mesmo. Se realizou um estudo descritivo retrospectivo das coortes que ingressaram nos dois períodos acadêmicos do 2003 e da informação acadêmica das coortes de estudantes registrados no curso entre os anos 2003 e 2008. Os dados se analisaram desde as perspectivas longitudinal e transversal. Resultados: A desvinculação definitiva total nas coortes que ingressaram nos dois períodos acadêmicos de 2003 foi de 47% e 36%, a desvinculação temporal foi de 29% e 36%, e obtiveram o grau no tempo previsto o 22% e 19% dos estudantes respetivamente. A desvinculação média em cada período acadêmico entre 2003 e 2008 foi 7,1%. A principal explicação para a deserção foi de índole acadêmica. Discussão: as percentagens de deserção e o atraso acadêmico no currículo tradicional de medicina entre 2003 e 2008 foram altos, similares aos da educação superior na Colômbia. Entre a complexidade que caracteriza este fenômeno, as estratégias pedagógicas e os aspetos acadêmicos e curriculares parecem desempenhar um papel preponderante. Esta coorte histórica e seus indicadores de deserção servirão de base de comparação para o novo currículo do programa de Medicina recentemente instaurado.

El tiempo de los estudiantes de medicina en las rotaciones clínicas y el sistema de créditos / Medical Student's Use of Time during Clinical Clerkships and the Credits Based System

Introducción: La formación en ciencias clínicas del pregrado de medicina se fundamenta en rotaciones clínicas. Para implementar el sistema de créditos es necesario conocer cómo se llevan a cabo estas experiencias. Objetivo: Describir cómo los estudiantes utilizan el tiempo durante las rotaciones clínicas, el valor académico y el grado de disfrute que le asignan a las actividades. Metodología: Estudio descriptivo con una muestra aleatoria estratificada de cien estudiantes de los semestres clínicos. Se recolectó información sobre el tiempo empleado durante una semana, el valor educativo y el grado de disfrute de las actividades de las rotaciones clínicas. Los datos fueron analizados en Excel® 98 y SPSS. Resultados: Las actividades de un día ocuparon en promedio 10.8 h, con 7.3 h (69%) dedicadas a actividades académicas. La actividad asistencial con docente representó el mayor porcentaje de utilización del tiempo (15.4%). Durante una semana, el 56% (28 h) del tiempo efectivo estuvo dedicado al trabajo asistencial y 22.4 h (44.5%) al trabajo independiente en el sitio de práctica. El tiempo dedicado al aprendizaje en la rotación clínica corresponde a 19 créditos para un semestre de 18 semanas. Las actividades calificadas con mayor valor educativo fueron el estudio independiente por fuera de la institución (4.6) y las actividades académicas con el docente (4.5). Las calificadas como de mayor disfrute fueron las extracurriculares y la docencia formal. Conclusiones: Los estudiantes tienen mayor tiempo de contacto con los pacientes que el reportado en la literatura. El trabajo presencial de nuestros estudiantes es mayor al reportado en estudios similares.

Introduction: Comprehensive undergraduate education in clinical sciences is grounded on activities developed during clerkships. To implement the credits system we must know how these experiences take place. Objectives: to describe how students spend time in clerkships, how they assess the educative value of activities and the enjoyment it provides. Method: We distributed a form to a random clustered sample of a 100 students coursing clinical sciences, designed to record the time spent, and to assess the educative value and the grade of enjoyment of the activities in clerkship during a week. Data were registered and analyzed on Excel® 98 and SPSS. Results: mean time spent by students in clerkship activities on a day were 10.8 hours. Of those, 7.3 hours (69%) were spent in formal education activities. Patient care activities with teachers occupied the major proportion of time (15.4%). Of the teaching and learning activities in a week, 28 hours (56%) were spent in patient care activities and 22.4 hours (44.5%) were used in independent academic work. The time spent in teaching and learning activities correspond to 19 credits of a semester of 18 weeks. The activities assessed as having the major educational value were homework activities (4.6) and formal education activities (4.5). The graded as most enjoyable were extracurricular activities, formal educational activities and independent academic work. Conclusion: our students spend more time in activities with patients than the reported in literature. The attending workload of our students is greater than the one reported in similar studies.