RESUMEN
RATIONALE: Total absence of superior vena cava (ASVC) is a very rare anomaly, and the patient usually suffers from superior vena cava syndrome (SVCS) or conduction disturbances. PATIENT CONCERNS: We report a 36-year-old white male, born and living in Brazil, without comorbidities presented to hematologist thrombotic episodes even under anticoagulant therapy. On his first hematologic appointment, he had no active complaints except by the fullness after meals, and his physical examination presented remarkable collateral circulation in the chest. DIAGNOSES: Congenital ASVC associated with factor V Leiden mutation. OUTCOMES: In his magnetic resonance angiography of the thorax, a great amount of collateral circulation and communication of the azygos and hemiazygos veins with inferior vena cava were evident, as well as the absence of the upper cava vein. Furthermore, heterozygous genetic mutation was found for Leiden factor V. LESSONS: This case gives us the lesson that we need to include ASVC in the differential diagnosis of SVCS. The importance of the V-Leiden factor as a joint risk with this congenital defect for venous thromboembolism episodes was also highlighted.
Asunto(s)
Factor V/genética , Mutación , Malformaciones Vasculares/patología , Vena Cava Superior/anomalías , Trombosis de la Vena/diagnóstico , Adulto , Anticoagulantes/uso terapéutico , Vena Ácigos/anomalías , Vena Ácigos/diagnóstico por imagen , Brasil , Circulación Colateral , Diagnóstico Diferencial , Resultado Fatal , Heterocigoto , Humanos , Angiografía por Resonancia Magnética/métodos , Masculino , Síndrome de la Vena Cava Superior/diagnóstico , Síndrome de la Vena Cava Superior/etiología , Tórax/irrigación sanguínea , Tórax/diagnóstico por imagen , Tórax/patología , Tomografía Computarizada por Rayos X/métodos , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/diagnóstico por imagen , Vena Cava Superior/patología , Trombosis de la Vena/etiologíaRESUMEN
PURPOSE: Implement a constructivist approach in thoracic drainage training in surgical ex vivo pig models, to compare the acquisition of homogeneous surgical skills between medical students. METHODS: Experimental study, prospective, transversal, analytical, controlled, three steps. Selection, training, evaluation. INCLUSION CRITERIA: a) students without training in thoracic drainage; b) without exposure to constructivist methodology. 2) EXCLUSION CRITERIA: a) students developed surgical skills; b) a history of allergy. (N = 312). Two groups participated in the study: A and B. Lecture equal for both groups. Differentiated teaching: group A, descriptive and informative method; group B, learning method based on problems. A surgical ex vivo pig model for training the chest drain was created. Were applied pre and post-test, test goal-discursive and OSATS scale. RESULTS: Theoretical averages: Group A = 9.5 ± 0.5; Group B = 8.8 ± 1.1 (p = 0.006). Medium Practices: Group A = 22.8 ± 1.8; Group B = 23.0 ± 2.8 (p <0.001). CONCLUSION: Through the constructivist methodology implemented in the thoracic drainage training in surgical ex vivo pig models, has proven the acquisition of surgical skills homogeneous compared among medical students.
Asunto(s)
Drenaje , Educación de Pregrado en Medicina/métodos , Modelos Anatómicos , Modelos Educacionales , Toracotomía/educación , Animales , Competencia Clínica , Drenaje/instrumentación , Evaluación Educacional , Femenino , Humanos , Masculino , Aprendizaje Basado en Problemas/métodos , Porcinos , Toracotomía/instrumentaciónRESUMEN
ABSTRACT PURPOSE: Implement a constructivist approach in thoracic drainage training in surgical ex vivo pig models, to compare the acquisition of homogeneous surgical skills between medical students. METHODS: Experimental study, prospective, transversal, analytical, controlled, three steps. Selection, training, evaluation. Inclusion criteria: a) students without training in thoracic drainage; b) without exposure to constructivist methodology. 2) Exclusion criteria: a) students developed surgical skills; b) a history of allergy. (N = 312). Two groups participated in the study: A and B. Lecture equal for both groups. Differentiated teaching: group A, descriptive and informative method; group B, learning method based on problems. A surgical ex vivo pig model for training the chest drain was created. Were applied pre and post-test, test goal-discursive and OSATS scale. RESULTS: Theoretical averages: Group A = 9.5 ± 0.5; Group B = 8.8 ± 1.1 (p = 0.006). Medium Practices: Group A = 22.8 ± 1.8; Group B = 23.0 ± 2.8 (p <0.001). CONCLUSION: Through the constructivist methodology implemented in the thoracic drainage training in surgical ex vivo pig models, has proven the acquisition of surgical skills homogeneous compared among medical students.