The First Latin American Consensus on Superficial and Perforating Venous Mapping.

With the aim of obtaining a map which is useful as a diagnostic tool and therapeutical orientation, complementing the written report of duplex ultrasound venous study, Latin-American Scientific Societies of Phlebology, Vascular Surgery and Vascular Imaging were invited to participate, through their regional representatives, to the First Consensus of Superficial and Perforating Venous Mapping. A consensus process using a modified Delphi method was carried out. An International Working Group was formed, which developed a Prototype of the Venous Mapping that worked as a starting point for consensus, and was presented in a first virtual meeting of 54 experts (societies' representatives) when the methodology was explained. For the consensus process, two rounds of self-administrated questionnaires with feedback were used. In the first questionnaire a 100% consensus was obtained in the 15 statements (an agreement range of 85.2% to 100%) In the analysis of qualitative data, three categories according to the actions to implement were identified - actions which involved no action, minor changes and major changes. This analysis was used to build the second questionnaire, which reached a consensus in its six statements (agreement range of 87.1% to 98.1%). A final consensus on every field proposed was established with the approval of all the experts consulted and it was presented at a third online meeting. The document of the superficial and perforating venous mapping reached by consensus is presented hereafter.

Teaching strategies and outcomes in 3 different times of the COVID-19 pandemic through a dynamic assessment of medical skills and wellness of surgical trainees.

BACKGROUND: The coronavirus disease 2019 pandemic had a substantial impact on surgical training programs. This study describes the teaching strategies and outcomes in 3 different times of the coronavirus disease 2019 pandemic through a dynamic assessment of medical skills and well-being of trainees. METHODS: Three surveys were administered during 2020 to general surgery residents and fellows in a university hospital in Argentina. Perceptions on the impact of coronavirus disease 2019 were described. The stress rate and risk factors were analyzed. RESULTS: The study included 124 answers. In total, 59% were men, 82% of trainees reported concerns about the loss of surgical skills in early phase 1. Time spent with academic activities increased in 94.5% of the cases. Owing to the prompt implementation of changes, by the end of 2020, 73% participated in a greater number of procedures (P = .003); personal protective equipment use related problems dropped from 40% to 14% (P = .031), and the lack of adequate spaces where trainees could express reduced from 28% to zero. Half of the trainees felt stressed, and 18% required psychological assistance; reporting problems with personal protective equipment use was identified as a risk factor (P = .012). CONCLUSION: Assessing trainees' perceptions at 3 different times of the coronavirus disease 2019 pandemic enabled the implementation of dynamic changes. The negative impact on surgical training was partially offset by the optimal use of virtual learning. Half of them felt stressed, identifying problems in the use of personal protective equipment as a predisposing factor.

Amyand's hernia complicated with appendicitis.

Introduction: The finding of a vermiform appendix within the peritoneal sac of an indirect inguinal hernia occurs in approximately 1% of cases. However, the presence of appendicitis within an inguinal hernial sac is found only in 0.08% of the general population. Case Report: We present the case of a 58-year-old male patient that was admitted with abdominal pain associated with a small non-reducible right groin mass. Discussion: To establish the correct diagnosis preoperatively, an abdominal and pelvic CT scan is mandatory. Conclusion: Acute appendicitis in an Amyand's hernia is a very rare entity that can be easily misdiagnosed preoperatively. CT is extremely useful in reaching the correct preoperative diagnosis.

Introducción: El hallazgo de un apéndice vermiforme dentro del saco peritoneal de una hernia inguinal indirecta ocurre en aproximadamente el 1% de los casos. Sin embargo, la presencia de apendicitis dentro de un saco herniario inguinal se encuentra sólo en el 0.08% de la población general. Caso clínico: Presentamos el caso de un paciente masculino de 58 años que ingresa por dolor abdominal asociado a una pequeña masa inguinal derecha no reducible. Discusión: Para establecer el diagnóstico correcto preoperatorio, es obligatoria una tomografía computarizada de abdomen y pelvis. Conclusión: La apendicitis aguda en la hernia de Amyand es una entidad muy rara que puede diagnosticarse erróneamente fácilmente en el preoperatorio. La TC es de gran utilidad para llegar al correcto diagnóstico preoperatorio.

Recurrent primary enterolithiasis with no apparent cause. Presentation of a case / [Enterolitiasis primaria recurrente idiopática. Presentación de un caso]

Enterolithiasis is a rare cause of intestinal obstruction. It occurs with a low frequency and its etiology can be primary or secondary. They present nonspecifically clinically and their resolution is usually surgical. We present a case of a 45-year-old patient who presented two episodes, one year apart, of intestinal obstruction due to enteroliths of unknown cause. The recurrence of this pathology, for no apparent reason, is what makes this publication interesting.

La enterolitiasis es una causa poco frecuente de obstrucción intestinal. Su etiología puede ser primaria o secundaria, según el sitio de formación de los litos. Se presentan clínicamente de manera inespecífica y su resolución es habitualmente quirúrgica. Se presenta un caso de una paciente de 45 años que presentó dos episodios, separados por un año, de obstrucción intestinal por enterolitos de causa desconocida. La recurrencia de esta patología, sin causa de base aparente, es lo que hace interesante esta publicación.

Secondary Ablation of Recanalized Saphenous Vein after Endovenous Thermal Ablation.

BACKGROUND: To describe the occlusion rate and clinical response of a redo ablative procedure in symptomatic patients with recanalization of saphenous vein after endovascular thermal ablation. METHODS: A retrospective cohort study was performed in a prospectively collected data of symptomatic patients with recanalization of the great saphenous vein (GSV) or small saphenous vein (SSV) after endovascular thermal ablation who underwent a secondary ablation (SA) from June 2015 to May 2018. RESULTS: Ten patients (15 limbs) with recanalization of the GSV or SSV were treated with SA. The median age was 67 years and 60% were men. The median time from the first ablation was 7.3 years (interquartile range [IQR] 6.5-9.6). For SA, radiofrequency ablation was performed in 12 limbs (80%) and ultrasound-guided foam sclerotherapy in 3 cases (20%). The GSV was the treated vessel in 14 cases (93.3%). No complications were reported. Median follow-up was 13 months. Preoperative and 1-year follow-up Venous Clinical Severity Score was 9 (IQR 5-10) and 4 (IQR 2-8), respectively. Duplex ultrasound evaluation after 1 year showed an occlusion rate of 93.3% evidencing a partially recanalized vein in 1 treated limb. CONCLUSIONS: In this study, the occlusion rate was 93.3% at 1 year after SA; clinical improvement and no complications were reported. SA appears to be a valid option for the treatment of symptomatic patients with recanalized GSV or SSV.

Arteriovenous Fistula after Endovenous Laser Ablation of Great Saphenous Vein Treated with Covered Stent: Case Report and Literature Review.

Endovenous ablation techniques (radiofrequency or laser) have become the less invasive choice of treatment for superficial venous insufficiency due to saphenous vein incompetence showing high effectiveness and few complications. We present a case of symptomatic arteriovenous fistula between the external iliac artery and vein after endovenous laser ablation repaired with covered stent. We also review the literature and discuss the possible causes and management of this unusual and potentially severe complication, and the feasibility of endovascular treatment.

Nervio laríngeo inferior no recurrente tipo I / Type-1 non-recurrent inferior laryngeal nerve

La variante no recurrente del nervio laríngeo recurrente (NLR) tiene una frecuencia que oscila entre el 0,25 y el 0,99% según las diferentes series informadas. El NLNR (nervio laríngeo no recurrente) es consecuencia de un desarrollo embriológico anómalo del tronco epiaórtico. Se presenta el caso de una paciente con la variante tipo I del NLNR como hallazgo intraoperatorio durante una tiroidectomía total. El NLNR es un variante anatómica rara; debe pensarse siempre que se haya buscado exhaustivamente de forma reglada el nervio laríngeo inferior derecho sin localizarlo en su sitio anatómico habitual.

The non-recurrent laryngeal nerve (NRLN) is a variant of the recurrent laryngeal nerve (RLN) with an incidence between 0.25 and 0.99% according to the different series reported. The NRLN is consequence of a vascular anomaly during the embryological development of the epiaortic trunk. We report the case of a woman with type-1 NRLN as an intraoperative finding during total thyroidectomy. The NRLN is a rare anatomic variant that should be suspected when the right inferior RLN cannot be identified in the usual anatomic location after a standardized exploration.

Estrategias farmacológicas para la discontinuación del uso de benzodiacepinas / Pharmacologic strategies for benzodiazepine discontinuation

En el presente artículo se evalúa la evidencia existente acerca de la eficacia de intervenciones farmacológicas y no farmacológicas para la discontinuación de benzodiacepinas en pacientes que las consumen de forma crónica. Se realiza una pequeña introducción al tema, se describe la estrategia de búsqueda, se resume una revisión sistemática que intentó responder la pregunta planteada y se expresan las conclusiones. La información disponible sugiere que la reducción gradual es preferible a la interrupción abrupta, sugiriendo el uso eventual de carbamazepina como coadyuvante.(AU)

Estrategias farmacológicas para la discontinuación del uso de benzodiacepinas / Pharmacologic strategies for benzodiazepine discontinuation

En el presente artículo se evalúa la evidencia existente acerca de la eficacia de intervenciones farmacológicas y no farmacológicas para la discontinuación de benzodiacepinas en pacientes que las consumen de forma crónica. Se realiza una pequeña introducción al tema, se describe la estrategia de búsqueda, se resume una revisión sistemática que intentó responder la pregunta planteada y se expresan las conclusiones. La información disponible sugiere que la reducción gradual es preferible a la interrupción abrupta, sugiriendo el uso eventual de carbamazepina como coadyuvante.