Viability and characterization trial of a novel method as an alternative to formaldehyde and Walter-Thiel cadaveric preservation for medical education and surgical simulation / Viabilidad y prueba de caracterización de un nuevo método como alternativa al formaldehído y la solución de Walther-Thiel para la preservación de cadáveres para educación médica y simulación quirúrgica

Introduction Despite its toxic and carcinogenic nature, formaldehyde is a widely used reactant for specimen preservation. With the need of specimens for both anatomical and surgical training, alternative preservation solutions (PS) have been proposed, however, their use is limited due to high costs and complexity. Hence, a new formaldehyde-free solution (FFS) is evaluated as a potential alternative for anatomical and surgical training. Methods Qualitative and Quantitative data were acquired. Specimens preserved using three different methods were selected. Flexibility was measured by joints goniometry and pneumoperitoneum pressures were evaluated followed by an exploratory laparoscopy. Undergraduate student's perceptions on cadavers preserved with different PS were obtained using surveys and focus groups. Results The main reason why cadaveric specimens were considered as useful tools was the perceived interaction with real tissues and the ‘practical’ concept of getting in touch with what students would be facing in the future as physicians, what we call “hands on” activities. FFS treated specimens showed better joint-movement ranges in comparison to other methods and pneumoperitoneum was acquired after 5mmHg CO2 pressure. Students appreciated working with corpses regardless the technique used, however FFS specimens were defined as less uncomfortable, while presenting no sensory discomfort. Conclusions Even though alternative PS are effective, high costs and complexity restrict their usage. Cadavers preserved with FFS had similar range of movements compared with Thiel. Students preferred to work with FFS rather than FF due to flexibility, color, and no sensorial hassles. Thus, we propose FFS as viable alternative to traditional PS (AU)

Introducción A pesar de su naturaleza carcinogénica y tóxica, el formaldehido continúa siendo utilizado para preservar especímenes. Debido a la necesidad de especímenes para entrenamiento anatómico y quirúrgico, se han propuesto soluciones preservadoras (SP) alternativas; sin embargo, su uso es limitado debido a los altos costos y a su complejidad. En consecuencia, se evalúa una nueva solución libre de formol (FFS) como una alternativa para el uso en entrenamiento anatómico y quirúrgico. Métodos Se obtuvieron datos cualitativos y cuantitativos. Se seleccionaron especímenes preservados utilizando diferentes métodos y se analizaron biopsias de cada uno. Se midió la flexibilidad mediante goniometría, y se evaluó la presión del neumoperitoneo. Utilizando encuestas y grupos focales se obtuvo la percepción de estudiantes de pregrado respecto a cadáveres preservados con diferentes soluciones. Resultados Los principales motivos por los que los estudiantes refirieron percibir los cadáveres como herramientas útiles fueron poder interactuar con tejidos reales y el concepto de «practicidad» generado por actividades percibidas como similares a la práctica como médicos profesionales. Los especímenes tratados con FFS demostraron mejor movimiento articular en comparación con otras soluciones, además de lograr neumoperitoneo con 5mmHg de CO2. Los estudiantes refirieron sentir menos molestias sensoriales al utilizar cadáveres preservados con FFS. Conclusiones Aunque otras SP son efectivas, los altos costos y la complejidad restringen su uso. Cadáveres preservados con FFS presentan arcos de movimiento similares a Thiel. Los estudiantes prefirieron trabajar con FFS en vez de FF, debido a la flexibilidad, el color y la ausencia de molestias sensoriales. Proponemos FFS como una alternativa viable a las SP tradicionales (AU)

[The therapeutic posture in desmoid tumor]. / Actitud terapéutica ante el tumor desmoide.

BACKGROUND: The desmoid tumor is a histologically benign neoplasm originating in muscular-aponeurotic structures and possesses a high tendency of local recurrence. The aggressive nature of the tumor obliges radical surgery to be performed principally in extra-abdominal tumors. METHODS: Twelve patients were treated from 1983 to 1993. The treatments performed prior to and after histologic diagnosis, the time of evolution when radical treatment was carried out upon diagnosis and the evolution after treatment were evaluated. RESULTS: Of the patients with desmoid tumor 8 were males with a mean age of 29.9 +/- 12.5 years. In eleven cases the presentation was as a tumor and was of pain in only one case. All the patients were surgically treated with a total of 27 interventions being carried out. Three patients also received pharmacologic treatment with tamoxifen, in 2 cases associated to sulindac. In two radiotherapy was used but not as a first line treatment. Following a mean follow up of 38 +/- 17 months no mortality has been registered but 5 patients are not disease free. CONCLUSIONS: The therapeutic attitude to the desmoid tumor should be radical surgery in both the primary tumor and the recurrences with medical treatment being performed in specific situations.

[Surgical treatment of acute cholecystitis. Results of an early intervention protocol]. / Tratamiento quirúrgico de la colecistitis aguda. Resultado de un protocolo de actuación precoz.

A prospective study of 425 patients operated for gallstones was undertaken in order to assess the applicability of a protocol including early surgery in acute cholecystitis. Acute cholecystitis (AC) was present in 119 patients who had 123 episodes of AC (28%). Of 114 patients diagnosed as having AC, 103 were operated on before 72 h and the remaining before 7 days. There were no significant differences between the AC series and that of 306 patients who underwent an elective operation, in regard to morbidity, mortality or length of hospitalization. Early cholecystectomy can be recommended for the treatment of AC as its results are comparable to those of elective surgery.

[Usefulness of echography with pancreatic stimulation in the evaluation of acute pancreatitis associated with pancreas divisum]. / Utilidad de la ecografía con estimulación pancreática en la valoración de la pancreatitis aguda asociada a un páncreas divisum.

Pancreas divisum is an anatomic variation of the fusion of the pancreatic ducts that appears in 6-10% of the normal population. In recent years, with the development of endoscopic cholangiopancreatography, pancreas divisum has been related to recurrent acute pancreatitis, although its continuous interrelation remains debated. We present a case of acute pancreatitis with pancreas divisum. Echography after pancreatic stimulation with secretin (EEPS) was useful to evaluate the degree of stenosis of the accessory papilla, showing dilatation maintained for 30 minutes of the dorsal duct after stimulation. Postoperative echography with secretin pancreatic stimulation after surgical sphincteroplasty showed no modification in the caliber of the accessory duct, which allowed us to discern the solution to the obstructive problem. We discuss the clinical utility and prognostic value of echography with secretin pancreatic stimulation in the treatment of pancreas divisum.

[Pancreas transplant]. / Trasplante de páncreas.

Pancreas transplantation offers the possibility of preventing the development and progression of diabetic lesions by adequate control of hydrocarbon metabolism. Moreover, the diabetic patient is freed from dietary and physical restrictions, as well as from insulin treatment. However, this is achieved at the expense of an immunosuppression not always free of risk. For this reason, up to now, the transplantation has been reserved to those patients at a risk higher than that of immunosuppression: uremic patients who also require a kidney transplantation, patients suffering of preproliferative retinopathy, and those patients with urine protein above 150 mg/24 hours but less than 3 g/24 hours. The introduction of cyclosporine has greatly improved the transplantation results, achieving a 53% actuarial survival of the graft per year. Out of the different technics used, the one that yields best results is the transplantation of the whole organ, deriving the exocrine secretion to the urinary bladder. This method also enables early diagnosis of graft rejection by monitoring urine amylase.