Fellows perspective of HPB training in Latin America.

BACKGROUND: Currently, no standards for HPB training exist in Latin America. The aim of this work is to evaluate fellows' experience of HPB training and the areas of opportunity to improve. METHODS: A 35 points survey was developed and distributed among fellows from dedicated HPB training programs in Latin America. The survey was applied by direct phone call (37%) or web based (63%), to fellows graduated between 2010 and 2014, from 7 different programs. RESULTS: Thirty-nine fellows from Argentina, Brazil, Chile and México were considered with a response rate of 82% (32/39). Most fellows (90%) shared cases with more than one co-fellow. Scrubbing with chief residents ocurred to 60% of fellows; only 14% of fellows noted having a primary surgeon role in more than 70% of cases. Median number of major hepatectomies during training was 15 (1-100), Whipple procedures 6 (1-40), and major bile duct repair 20 (1-80). Limited funding was the main reason to avoid HPB programs outside the country of origin. CONCLUSION: HPB training in Latin America requires more operative volume and autonomy. Financial burden is the main limitation to pursue training overseas. A multinational fellowship that takes advantage of each center may overcome differences in volume and type of cases.

Mediastinal Myxoid Liposarcoma with Intrapericardial Involvement and Large Pericardial Effusion.

Liposarcoma is the name given to a group of soft tissue sarcomas (STSs) with adipocytic differentiation. As a group, liposarcomas are the second most common STSs in adults. In 1951 Kozonis et al published that in the English language only four cases of liposarcomas originating in the mediastinum had been described. Primary mediastinal liposarcoma is an uncommon neoplasm of intrathoracic origin. We present the case of a 47-year-old woman diagnosed with a large mediastinal mass with intrapericardial invasion and massive pericardial effusion; biopsies showed a mediastinal liposarcoma.

Divertículo solitario de ciego como causa de abdomen agudo / Lonely Blind Dive like cause of acute abdomen

La presencia del divertículo solitario en el colon derecho fue descrita ya en 1912 por Potier. Esta entidad se diferencia claramente de la enfermedad diverticular del colon porque ésta se caracteriza por múltiples divertículos. Otra diferencia radica en que el divertículo solitario constituye un divertículo verdadero que compromete todas las capas del intestino, mientras que la enfermedad diverticular del colon evidencia divertículos falsos y es más común en el lado izquierdo. La prevalencia del divertículo solitario del ciego es de 0.17% en la población general y constituye 1% a 2% de los casos de divertículos en la población del hemisferio occidental. Su etiología en la mayoría de casos es congé- nita y muchos de ellos cursan de manera silente. En un 80% de las veces se encuentran a una distancia entre 1 a 2 cm de la válvula ileocecal y un 60% se localizan en la cara anterior del ciego

The presence of the solitary diverticulum in the right colon was already described in 1912 by Potier. This entity clearly differs from diverticular disease of the colon because it is characterized by multiple diverticula Another difference is that the solitary diverticulum constitutes a true diverticulum that compromises all layers of the intestine while diverticular disease of the colon evidences False diverticula and is more common on the left side. The prevalence of the solitary diverticulum of the blind is 0.17% in the general population and constitutes 1% to 2% of cases of diverticula in the population of Western hemisphere. Its etiology in most cases is congé- Nita and many of them attend silently. 80% of the time they are at a distance between 1 to 2 cm from the ileocecal valve and 60% are located on the front of the blind