Síndrome de Boerhaave: manejo diagnóstico y terapéutico en el Hospital Regional de Talca / Boerhaave Syndrome: diagnostic and therapeutic management at the Hospital Regional de Talca

Introduction: Boerhaave syndrome is a spontaneous rupture of the esophageal wall caused by a sudden increase in intraesophageal pressure. It represents an incidence of approximately 15% of all esophageal perforations, which do not exceed 3.1 per 1 million inhabitants per year. Objectives: To communicate the clinical presentation and management of patients with this syndrome, as well as to reveal the different options available in our service for its treatment. Methods: Search in the statistical data of the regional Hospital of Talca for patients with a diagnosis of Boerhaave syndrome. Five patients were found. Information was obtained from their clinical records and is presented as a clinical case report with a descriptive analysis of their management. Results: Of the 5 clinical cases presented, a classic clinical presentation can be observed, most of the patients presented with vomiting that later evolved with thoracic and/or epigastric pain, associated with imaging studies suggesting esophageal perforation. Management was surgical in 100% of the cases, applying different techniques described in the literature. Discussion and Conclusion: Boerhaave syndrome is a medical-surgical emergency that requires timely management. In spite of the variety of management and the consequences of each one of them, all the patients had an evolution that allowed them to preserve their lives until nowadays. Keeping a high index of suspicion and choosing the best management will have an impact on morbidity and mortality.

Presencia de burnout en estudiantes de postgrado de medicina de la Universidad Católica del Maule / Presence of burnout in medical graduate students from the Catholic University of Maule

Burnout is a psychological syndrome generated as a consequence of prolonged exposure to interpersonal stressors at work. Maslach and Jackson (1976) defined it as a syndrome of emotional exhaustion, depersonalization and low personal fulfillment; that occurs in individuals who work with people, damaging their quality of life and worsening their care work. There is growing concern about the presence of this syndrome in educational environment of medical schools. Given this reality, it was decided to make a diagnosis of the current situation of our residents of the Faculty of Medicine of the Catholic University of Maule (UCM). A validated and anonymous survey is carried out to all graduate students of different medical specialties to determine the presence of this syndrome. The results showed that burnout is present in 14% of our graduate students. Furthermore, it was observed that a high percentage of them manifest isolated characteristics of this syndrome; which leads us to conclude that we must work urgently to improve educational environments in our clinical field at Hospital Regional de Talca.

Simpatectomía torácica, solución para hiperhidrosis / Toracic Sympathectomy, solution for hyperhidrosis

PREFACE: Videothoracoscopic sympathectomy (VTS) is the gold standard treatment for the upper extremity hyperhidrosis (HH) because it is safe and has good results. OBJECTIVE: To evaluate retrospectively the long term results of VTS for the treatment of HH on 50 operated patients in the Maule Region from the year 2003 to september of 2015. METHODS: For axillary HH a T2 to T4 VTS was performed, and T3 VTS for palmar HH. All the patients were operated bilaterally through 2 axillary ports. The operatory sucess was evaluated through the persistence or not of sweating of the palm and armpit. Also, all the complications associated were registered. RESULTS: The procedure was successful in 96% of the patients, who reached anhidrosis in the palms and armpits. The most common complication was compensatory sweating, minimal to mild in 28% of the patients aproximately, severe only in one case; intense post operatory pain in 3 cases and sympathyc reinervation in 2 cases. There was no Infection, Horner syndrome, inthercostal arthery injury or mortality reported. CONCLUSION: The billateral VTS is an effective and safe procedure to obtain anhidrosis in patients with upper extremity hyperhidrosys.