Percepción de los residentes sobre el impacto de la pandemia COVID 19 en la formación en profesionalismo / Residents ́perspective of the impact of the COVID 19 pandemic on professional competency training

Introducción: el profesionalismo es clave para construir la identidad de los profesionales sanitarios. El objetivo de este trabajo ha sido conocer en un colectivo de residentes, la influencia de la primera ola de la pandemia por SARS-CoV2 en sus competencias del profesionalismo. Materiales y métodos: estudio descriptivo transversal mediante cuestionario electrónico, remitido a 167 residentes, para medir su percepción sobre el impacto de la pandemia COVID-19 en el profesionalismo, con una escala verbal de cuatro niveles: excelente, por encima de lo esperado, lo esperado, por debajo de lo esperado. Se realizó, además, una pregunta abierta de "reflexión personal" analizada cualitativamente mediante un proceso de triangulación. La encuesta se hizo en el Hospital Universitario Fundación Alcorcón en los dos meses siguientes a la primera ola pandémica. Resultados: respondieron 59 residentes (35,3%) de 21 especialidades. Sus lugares de trabajo fueron muy variados. Los atributos del profesionalismo valorados por encima de esperado o excelente fueron: trabajo en equipo (74,6%), empatía (71,2%) y responder a las necesidades del paciente por encima de las propias (69,5%). Se encontró por debajo de lo esperado la gestión de las emociones (22%). Discusión: la pandemia COVID-19 ha contribuido a reforzar la identidad profesional de los residentes, manifestándose a través de muchas dimensiones del profesionalismo. La gestión de las emociones fue la que obtuvo menor valoración.

Introduction: Professionalism is essential to build the identity of health professionals. The aim in this study was to determine, in a group of residents, the influence of the first wave of SARS-CoV2 pandemic on their professionalism competencies. Methods: Cross-sectional descriptive study with an electronic survey sent to 167 residents of Hospital Universitario Fundación Alcorcón to assess their perception of the impact of COVID-19 pandemic on professionalism, with a four-level verbal scale: excellent, above expected, expected, below expected. In addition, an open-ended "personal reflection" question was qualitatively analyzed through a triangulation process. The survey was completed immediately after the first pandemic wave. Results: The questionnaire was answered by 59 residents (35.3%) of 21 specialties from different workplaces. The attributes of professionalism rated above expected or excellent were: teamwork (74.6%), empathy (71.2%) and responding to patient's needs above their own (69.5%). Management of emotions (21%) was found to be below expectations. Discussion: COVID-19 pandemic has contributed to reinforce the professional identity of the residents, expressing itself through many dimensions of professionalism. Emotional management was the lowest rated.

Variante anatómica sintomática de la duplicación de la vía biliar común tipo IV.

INTRODUCTION: Duplicity of the common bile duct is an unusual congenital disorder. CASE REPORT: A 80-year-old woman with duplication of the common bile duct with retrograde endoscopic cholangiopancreatography (ERCP) who did not resolve the symptoms. DISCUSSION: Our case is a variant of type IV to the classification of duplicity of the common bile duct. The magnetic resonance cholangiography and presurgical ERCP allows assessment of the bile ducts, their caliber, and assessment of abnormalities. The treatment before duplicity of the common bile duct will depend on the clinic and the type of opening of the accessory common bile duct. CONCLUSIONS: It is important to perform a pre-surgical study and during surgery with intrasurgical cholangiography.

INTRODUCCIÓN: La duplicidad del conducto biliar común es una alteración congénita insólita. CASO CLÍNICO: Mujer de 80 años con duplicación de la vía biliar común con colangiopancreatografías retrógradas endoscópicas (CPRE) que no solventan la clínica. DISCUSIÓN: Nuestro caso es una variante del tipo IV de la clasificación de duplicidad del conducto biliar común. La colangiopancreatografía por resonancia magnética y la CPRE prequirúrgica permiten valorar las vías biliares, su calibre y sus posibles anormalidades. El tratamiento dependerá de la clínica y del tipo de apertura del conducto biliar común accesorio. CONCLUSIONES: Es importante realizar un estudio prequirúrgico y durante la cirugía con colangiografía intraoperatoria.

[A randomized controlled trial of preoperative oral immunonutrition in patients undergoing surgery for colorectal cancer: hospital stay and health care costs]. / Estudio prospectivo y randomizado sobre inmunonutrición oral preoperatoria en pacientes intervenidos por cáncer colorrectal: estancia hospitalaria y costos sanitarios.

BACKGROUND: The use of enteral formulas with immunonutrients in patients with gastrointestinal malignancies susceptible to surgery can reduce postoperative morbidity, at the expense of reduced infectious complications, with the consequent reduction in hospital stay and health care costs. MATERIAL AND METHODS: Prospective randomized study. 84 patients operated on a scheduled basis for resectable colorectal cancer were recruited. In the group YES IN Impact © Oral was administered for 8 days (3 sachets a day), compared with the NOT IN group who did not receive it. RESULTS: 40.5% (17) patients without immunonutrition suffered infectious complications vs. 33.3% (14) of YES IN. In patients with rectal cancer NOT IN, 50% (8) suffered minor infectious complications (p=.028). In each group (YES IN, NOT IN, colon and rectal cancer) when infectious complications were observed, the variables total hospital stay and costs doubled, with significant differences. These variables showed higher values in the group NOT IN compared with those who received immunonutrition, although these differences were not statistically significant. CONCLUSIONS: NOT IN patients suffered infectious complications more frequently than YES IN, with significant results in the subgroup of patients with rectal cancer. The total hospital stay and costs were slightly higher in the group not supplemented, doubling in each category significantly (YES IN, NOT IN, colon and rectal cancer), when infectious complications were observed.

[Axillary hidrosadenitis due to Leishmania: Case report and literature review]. / Hidrosadenitis axilar por Leishmania: presentación de un caso y revisión de la bibliografía.

BACKGROUND: Hidradenitis is a disorder where abscesses appear after the infection of the apocrine sweat glands. It is located normally in the axillae, groin, perineal region, and the scalp. CLINICAL CASE: A 37 year old male was referred by his GP to the General Surgery Department with axillary hidradenitis which had evolved over the years. The physical examination shows signs of hidradenitis in both axillae, with a noticeable suppurative hidradenitis in the right armpit. En bloc extirpation was performed to remove the whole affected area. The pathological examination revealed a cutaneous leishmaniasis. Subsequently, fucidin was administered topically, as well as local infiltrations of one millilitre of Glucantime™. DISCUSSION: Hidradenitis normally appears in intertriginous areas and its manifestation is accompanied by recurrent subcutaneous nodules. The incidence rate in females is three times higher than in males. The isolated Hidradenitis caused by Leishmania is a rare condition presented only in endemic areas or in immunocompromised patients, such as HIV-infected patients. Clinical manifestations can be different and the diagnosis can be confirmed through haematoxylin-eosin. The main pattern displays a disorganised granuloma without necrosis. Systemic or topical treatment can be applied. Immunotherapy treatment is the most common. CONCLUSIONS: Hidradenitis caused by Leishmania in HIV-negative patients is a rare condition. Therefore it is important to perform a good histological diagnosis and to administer the right treatment.

[Abdominal compartment syndrome by tension pneumoperitoneum secondary to barotrauma. Presentation case]. / Síndrome compartimental abdominal por neumoperitoneo a tensión secundario a barotrauma. Presentación de un caso.

BACKGROUND: Pneumoperitoneum is defined as the existence of extraluminal air in the abdominal cavity. In 80-90% of cases is due to perforation of a hollow organ. However, in 10-15% of cases, it is nonsurgical pneumoperitoneum. OBJECTIVE: The case of a patient undergoing mechanical ventilation, developing abdominal compartment syndrome tension pneumoperitoneum is reported. CLINICAL CASE: Female, 75 years old asking for advise due to flu of long term duration. Given her respiratory instability, admission to the Intensive Care Unit is decided. It is then intubated and mechanically ventilated. Chest x-ray revealed a large pneumoperitoneum but no pneumothorax neither mediastinum; and due to the suspicion of viscera perforation with clinical instability secondary to intra-abdominal hypertension box, emergency surgery was decided. CONCLUSIONS: When discarded medical history as a cause of pneumoperitoneum, it is considered that ventilation is the most common cause. Benign idiopathic or nonsurgical pneumoperitoneum, can be be treated conservatively if the patient agrees. But if intraabdominal hypertension prevails, it can result in severe respiratory and hemodynamic deterioration, sometimes requiring abdominal decompression to immediately get lower abdominal pressure and thus improve hemodynamic function.

[Amyand's hernia: a report of two cases and review of the bibliography]. / Hernia de Amyand: presentación de dos casos y revisión de la bibliografía.

BACKGROUND: Presence of the vermiform appendix in an inguinal hernia sac is an uncommon finding (1%), exceptionally rare if it's inflamed (0.13%). Clinically simulating incarcerated inguinal hernia and proper preoperative diagnosis is exceptional. We present two unusual cases of Amyand's hernia, and review of the bibliography. CLINICAL CASES: 1. Male patient 78 year old with an incarcerated right inguinal hernia which was performed preoperatively the diagnosis of Amyand's hernia by abdominal Computed Tomography. Clinical case 2. Female patient 82 year old with symptoms of an incarcerated right femoral hernia that finally showed an Amyand's hernia through a right inguinal hernia. CONCLUSIONS: Amyand's hernia is a rare entity whose preoperative diagnosis is uncommon, that it should always be considered in the differential diagnosis in cases with clinical signs of incarcerated right inguinal hernia.

Antecedentes: encontrar el apéndice vermiforme en un saco herniario inguinal es un hallazgo infrecuente (1%), excepcionalmente raro si está inflamado (0.13%). Clínicamente simula una hernia inguinal incarcerada y el diagnóstico preoperatorio adecuado se establece en contadas excepciones. Se reportan dos casos excepcionales de hernias de Amyand y se revisa la bibliografía. Casos clínicos: 1. Paciente masculino de 78 años con una hernia inguinal derecha, incarcerada, en el que el diagnóstico de hernia de Amyand se estableció antes de la cirugía mediante tomografía computada abdominal. Caso clínico 2. Paciente femenina de 82 años de edad, con clínica de hernia crural derecha incarcerada con una hernia de Amyand a través de una hernia inguinal derecha. Conclusiones: la hernia de Amyand es una rara enfermedad cuyo diagnóstico preoperatorio es infrecuente y que siempre debe considerarse en el diagnóstico diferencial en los casos con signos clínicos de hernia inguinal derecha incarcerada.

[Fibromatosis breast in the male. Case study]. / Fibromatosis mamaria en el varón. A propósito de un caso.

BACKGROUND: mammary fibromatosis is a rare pathology. It constitutes 0.2% of breast cancers, and case in men are exceptional. The definitive diagnosis is histological. CLINICAL CASE: we report the case of a male of 52 years, diagnosed with breast fibromatosis after pathologic study of tumor in the right breast. Programmed surgery for excision with wide margins was done. We performed a mastectomy of the subcutaneous fibromatosis with a pathologic study with clear margins. The postoperative course was uncomplicated and did not require adjuvant therapy. At 6 months follow-up he remains free of disease. The treatment of choice is surgical excision with wide margins. Adjuvant treatment is controversial. CONCLUSIONS: the fibromatosis in the breast is very rare and an exceptional occurrence in men. Surgery is the definitive treatment; few results exist for adjuvant therapy.

Antecedentes: la fibromatosis mamaria es una enfermedad rara; sus casos son 0.2% de las neoplasias de mama, y en los varones es aún más rara. El diagnóstico definitivo es anatomopatológico. Caso clínico: se comunica el caso de un varón de 52 años, con diagnóstico anatomopatológico de fibromatosis mamaria posterior al estudio de un tumor en la mama derecha. Se le practicó exéresis con amplios márgenes, luego mastectomía subcutánea, con estudio histológico de fibromatosis con márgenes libres. El postoperatorio transcurrió sin complicaciones y no requirió tratamiento coadyuvante. En el seguimiento a seis meses continuaba libre de enfermedad. El tratamiento de elección es la escisión con amplios márgenes y el oncológico coadyuvante es motivo de controversia. Conclusiones: la fibromatosis en la mama es poco frecuente y su aparición en el varón excepcional. El tratamiento quirúrgico es el definitivo, no así la terapia oncológica neoadyuvante que sigue suscitando controversia.

Merkel cell carcinoma: case report and literature review.

BACKGROUND: Merkel cell carcinoma is an aggressive neuroendocrine cell carcinoma arising in the epidermis of patients aged >60 years. This lesion is found in sun-exposed areas and presents as a small violet raised nodule. It is usually painless and rapidly growing. Although its clinical presentation and characteristic histology are usually sufficient, immunohistochemical features are helpful in making an accurate diagnosis. CLINICAL CASE: We present the case of a 62-year-old male with epidermoid carcinoma of the lung who was treated with surgery and local radiation for 2 months. He presented a painless 8-cm subcutaneous mass of some weeks of evolution, without inflammatory signs. Computerized tomography demonstrated a mass of probable lymph node origin. Fine-needle aspiration biopsy (FNAB) reported malignant cells and excisional surgery of the mass was performed, revealing a subcutaneous Merkel cell carcinoma. CONCLUSIONS: Merkel cell carcinoma is a rare entity that develops in mature patients, often in sun-exposed areas, and presents cutaneous injury in intact skin. Definitive diagnosis is done using immunohistochemistry.

Angiosarcoma primario de mama y carcinoma papilar de tiroides sincrónico: presentación de un caso / Primary breast angiosarcoma and synchronous papillary carcinoma of thyroid: a case report

Presentamos el caso excepcional de paciente con angiosarcoma primario de mama y carcinoma papilar de tiroides sincrónicos. Mujer de 34 años con angiosarcoma primario en la mama derecha sometida a mastectomía simple. En el estudio de extensión se halló un incidentaloma tiroideo derecho compatible con carcinoma papilar que requirió tiroidectomía total y linfadenectomía del compartimento central en segundo tiempo. Los angiosarcomas primarios suponen menos del 0,05% de todos los tumores primarios malignos de la mama. El diagnóstico definitivo de estos tumores viene definido por el estudio anatomopatológico, que define tres grados: alto, bajo, intermedio, los cuales se relacionan de forma directa con la supervivencia. La prevalencia de los incidentalomas malignos tiroideos objetivados por PET varía del 14% - 30,9%. La planificación del tratamiento quirúrgico de las neoplasias incidentales tiroideas en pacientes con otro tumor primario debe analizarse de forma individualizada, según la supervivencia esperada del tumor primario

Present the exceptional case of a female patient with diagnostic of primary angiosarcoma of the breast and synchronous thyroid papillary carcinoma, we review the literature. Patient female 34 year old with diagnostic of primary angiosarcoma in the right breast, it was removed,in the extension study found an incidental thyroid papillary carcinoma that required total thyroidectomy and central lymphadenectomy in a second time. The primary angiosarcomas account for less than 0.05% of all primary malignant tumors of the breast. The definitive diagnosis is determined by the pathology study, which defines three grades: high, low and intermediate, which relate directlyto the survival. The prevalence of malignant thyroid incidentalomas was observed by PET varies from 14% to30,9%, according to different studies. Planning the surgical treatment of incidental thyroid malignancies in patients with other primary tumor should be analyzed individually,according the expected survival of the primary tumor

Proximal-type epithelioid sarcoma in pubis. Case report and review of the literature.

BACKGROUND: The "proximal-type" epithelioid sarcoma (PES) is a rare variant of conventional epithelioid sarcoma. It has been described in older patients in the proximal portion of the extremities with a predilection for the pelvis and perineum. It is clinically more aggressive, showing a higher incidence of recurrence, metastasis, resistance to chemotherapy and a higher mortality. We report the case of a patient with a PES of the pubic region and we review the previous literature. CLINICAL CASE: We report the case of a 57-year-old female with a painless, progressively growing mass in the region of the pubis. We performed surgical resection of the lesion with clear margins and histological and immunohistochemical study allowed the definitive diagnosis of PES. After 4 disease-free years, the patient had a tumor recurrence at the same location. We performed en bloc resection of the lesion and immunohistochemical study confirmed the recurrence of PES. The patient refused adjuvant therapy. Today, after 4 years of follow-up, the patient remains asymptomatic and without evidence of recurrence or distant disease. CONCLUSIONS: Diagnosis of PES is complex because histological findings may be confused with multiple tumors; therefore, immunohistochemical study is definitive. PES shows positivity for epithelial markers (cytokeratin and EMA), mesenchymal markers (vimentin) as well as CD34. According to what has been reported in the literature, surgical treatment with free margins is indicated, with adjuvant therapies when the risk of recurrence is high.

Gliomatosis peritonei: recurrence, treatment and surveillance.

BACKGROUND: Gliomatosis peritonei is the metastatic implantation of mature glial tissue within the peritoneal cavity of patients with ovarian teratomas. There is no clear guidance for how long these patients should be followed up. CLINICAL CASE: We report the follow-up imaging findings of a 33-year-old female with abdominal distension and abdominal pain and who was postoperatively diagnosed with immature ovarian teratoma with gliomatosis peritonei. CONCLUSIONS: Differentiation of peritoneal implants seems to be important for prognosis. Malignant transformations after several years cannot be excluded. Therefore, new studies will determine if it is necessary to create guidelines for the postsurgical monitoring of these patients.

Septic thrombophlebitis of the portal vein due to acute cholecystitis.

BACKGROUND: pylephlebitis is a rare complication of intraabdominal infections. Clinical presentation can be varied; therefore, it is necessary to carry out imaging tests for diagnosis. The treatment of choice is wide-spectrum antibiotic therapy and surgery for the source of infection. CLINICAL CASE: we report the case of a female with acute abdomen who was diagnosed with acute cholecystitis and right portal vein thrombosis. The patient underwent surgery and antibiotic treatment was necessary. CT scan showed hepatic infarction secondary to portal thrombosis. CONCLUSIONS: pylephlebitis presents high mortality rates without treatment; therefore, early diagnosis is necessary in order to initiate appropriate medical and surgical treatment.

Angiomyofibroblastoma of the right ischiorectal fosa.

BACKGROUND: angiomyofibroblastoma is a soft-tissue lesion. The vulvovaginal region of middle-aged females is the most frequent localization. Angiomyofibroblastoma is a well-circumscribed subcutaneous tumor at the vulva and perineum region. It is a painful and slow-growing tumor. It is often thought to represent a Bartholin's gland cyst. Treatment of choice is surgical excision. CLINICAL CASE: We describe the case of a 49-year-old female with a right vulvar tumor that had been growing for 2 years. Ultrasonography, computed tomography and magnetic resonance revealed a tumor at the right ischiorectal fossa. Diagnosis after surgical excision was angiomyofibroblastoma. CONCLUSIONS: angiomyofibroblastoma must be considered in the differential diagnosis of vulvovaginal tumors because its treatment differs from others lesions of that region.

Hemorragia digestiva baja e intususcepción subsecuente a tumor del estroma gastrointestinal / Gastrointestinal bleeding and intussusception due to gastrointestinal stromal tumor (GIST)

Introducción: Los tumores del intestino delgado representan 25 % de las neoplasias gastrointestinales, de ellos 0.2 y 1 % corresponde a tumores del estroma gastrointestinal. Su presentación clínica más frecuente es la hemorragia digestiva, siendo los tumores del estroma gastrointestinal responsables en 1 % de los casos. Este tipo de neoplasias también puede ser el origen de intususcepción, proceso patológico infrecuente en la edad adulta por representar únicamente 5 % de todas las obstrucciones intestinales. Caso clínico: Mujer que acudió al servicio de urgencias por dolor abdominal y hemorragia digestiva baja. Las pruebas complementarias no resultaron concluyentes. Tras laparotomía exploradora se diagnosticó intususcepción y hemorragia digestiva baja subsecuente a tumor del estroma gastrointestinal. Conclusiones: La cirugía debe ser el último recurso diagnóstico y terapéutico, pero es necesaria en ocasiones debido a la dificultad para determinar la causa etiológica de la hemorragia y la obstrucción intestinal.

BACKGROUND: Small bowel tumors comprise 25% of gastrointestinal (GI) neoplasms, of which only between 0.2 and 1% correspond to gastrointestinal stromal tumors (GIST). GI bleeding is the most common presentation of GIST, being responsible in 1% of the cases. This type of neoplasm can also be the origin of an intussusception, which is an infrequent process during adult age, representing only 5% of all intestinal obstructions. CLINICAL CASE: We report a case of a patient who arrived at the emergency department due to abdominal pain and lower GI bleeding. The diagnostic process was not conclusive. After an exploratory laparotomy, the diagnosis was GI bleeding and intussusception due to GIST. CONCLUSIONS: Surgery must be the last diagnostic and therapeutic resource, but it is sometimes necessary to localize bleeding and intestinal obstruction site.

Gastrointestinal bleeding and intussusception due to gastrointestinal stromal tumor (GIST).

BACKGROUND: Small bowel tumors comprise 25% of gastrointestinal (GI) neoplasms, of which only between 0.2 and 1% correspond to gastrointestinal stromal tumors (GIST). GI bleeding is the most common presentation of GIST, being responsible in 1% of the cases. This type of neoplasm can also be the origin of an intussusception, which is an infrequent process during adult age, representing only 5% of all intestinal obstructions. CLINICAL CASE: We report a case of a patient who arrived at the emergency department due to abdominal pain and lower GI bleeding. The diagnostic process was not conclusive. After an exploratory laparotomy, the diagnosis was GI bleeding and intussusception due to GIST. CONCLUSIONS: Surgery must be the last diagnostic and therapeutic resource, but it is sometimes necessary to localize bleeding and intestinal obstruction site.