Spontaneous intramural small-bowel hematoma: a cause of acute abdomen in anticoagulated patients.

Spontaneous intramural small-bowel hematoma (SISBH) is an uncommon cause of acute abdominal pain in anticoagulated patients.

Conversion from Roux-En-Y Gastric Bypass to Single Anastomosis Duodenoileal Bypass (SADI-S) for Weight Regain.

BACKGROUND: Revisional bariatric surgery presents a challenge for bariatric surgeons. This procedure can be considered for patients with inadequate weight loss or weight regain after an initial satisfactory response following bariatric surgery. However, the surgical management of weight regain following RYGB remains controversial. We present a case of successful weight gain management after a single anastomosis duodenoileal bypass with sleeve gastrectomy (SADIS) as a revisional procedure for patients with weight regain after RYGB. METHODS: A 23-year-old female with a body mass index (BMI) of 52 kg/m2 and no comorbidities underwent RYGB. Postoperatively, she reached an excess weight loss of 75% of her initial body weight, with a BMI of 32 kg/m2. Eight years after her RYGB, she started regaining weight, reaching a BMI of 47 kg/m2. The surgical team decided to perform a revisional surgery, a conversion of RYGB to SADIS. RESULTS: There were no intraoperative complications. An upper gastrointestinal series was obtained on the third postoperative day which resulted normal and oral feedings were resumed. The patient was then discharged on fifth postoperative day. There were no complications within the first 30 postoperative days. CONCLUSIONS: We attach a video that illustrates the management and technique used to deal with the weight regain after primary bariatric surgery RYGB. We consider that in patients with super morbid obesity refractory to RYGB, conversion to SADIS is an excellent alternative due to its safety and feasibility.

Brunneroma: an infrequent duodenal neoplasm.

An 83-year-old male presented to the Emergency Department with long lasting epigastric discomfort, weight loss and diarrhea. Physical exam and basic laboratory tests showed no remarkable findings. Upper endoscopy revealed a sessile lesion (Paris 0-IIa) in the anterior wall of the duodenal bulb, with smooth surface and slightly ulcerated at the top.

Prevalencia de síndrome de burnout en alumnos del séptimo año de medicina de una universidad privada de Lima, Perú / Prevalence of burnout syndrome in seventh year medical students from a private university of Lima, Peru

El síndrome de burnout (SBO) se ha descrito como una entidad patológica común entre los médicos y que podría originarse durante su formación académica. Objetivo: Determinar la prevalencia y los factores asociados al SBO en alumnos de medicina del séptimo año de la Universidad Peruana Cayetano Heredia (UPCH). Material y Métodos: Se realizó un estudio transversal con los estudiantes de medicina del séptimo año de la UPCH (n=117) durante diciembre del 2010. Se empleó dos encuestas autoadministradas anónimas, una sobre características sociodemográficas y laborales y otra, la escala Maslach Burnout Inventory en su versión Human Services Survey validada en español. Resultados: Se encontró una prevalencia de SBO de 57,2% (n=59). Más de la mitad de la población presentó niveles medio o alto en despersonalización (DP) (68,9% [n=71]) y agotamiento emocional (AE) (67% [n =69]) y aproximadamente un tercio de los estudiantes tuvieron baja realización personal (RP) (35% [n=36]). No se encontró asociación estadísticamente significativa entre las variables sociodemográficas y laborales estudiadas y la presencia de SBO. La presencia de enfermedad mental se asoció a niveles altos de DP y AE, mientras la ausencia de actividades extracurriculares se asoció a elevados puntajes en AE. Conclusiones: El SBO estuvo presente en más de la mitad de los internos de medicina de la UPCH. La presencia de enfermedad mental y ausencia de actividades extracurriculares se asociaron a las dimensiones del SBO.

Burnout syndrome has been described as a common pathology among physicians and that may begin during medical formation. Objective: To establish the prevalence of burnout and its associated factors in seventh year medical students of Universidad Peruana Cayetano Heredia (UPCH). Materials and Methods: A transversal study was preformed with seventh year medical students from UPCH (n =117) during December 2010. Two anonymous self-administered questionnaires were assessed, one of them included sociodemographic and laboral characteristics and the other included the Maslach Burnout Inventory û Human Services Survey version validated in Spanish. Results: The prevalence of burnout was established at 57,2% (n=59). Over one half of the population had middle or high levels on depersonalization (DP) (68,9% [n =71]) and emotional exhaustion (EE) (67% [n = 69]) and about one third of students presented low personal accomplishment (PA) (35% [n =36]). No statistical significance was found between sociodemographic and occupational variables studied and burnout. The presence of mental illness was associated with high levels of DP and EE, while the absence of extracurricular activities was associated with high levels of EE. Conclusions: Burnout is present in more than half of medical interns of UPCH. The presence of mental illness and the absence of extracurricular activities were associated with burnout dimensions.