Common surgical training program: standardization of learning quality. / Programa de formación quirúrgica común: uniformidad en la calidad del aprendizaje.

INTRODUCTION: The various surgical specialties in our center have used the simulation and experimental surgery resources available for their training tasks in minimally invasive surgery (MIS) in an individualized manner. With this learning model, a great dispersion of effort and expense was observed, so it was decided to create a unified program based on the following: shared learning, synergy among specialties, moderation of the economic cost, and rational use of the facilities. OBJECTIVE: To describe and assess our consensually designed training program in order to consolidate a shared learning strategy that will enable our residents to acquire and perfect surgical skills in MIS. MATERIALS AND METHODS: The program consists of various increasingly complex phases implemented on a continuous basis throughout the period of specialized training in the virtual laboratory and experimental operating room. The assessment methods were based on quantifiable criteria: percentage of efficiency and completion time of the "McGill Inanimate System for Training and Evaluation of Laparoscopic Skills" (MISTELS) exercises at the beginning and end of the program. An economic study was also conducted. RESULTS: 20 residents have completed the program. Mean times show a significant reduction in each of the exercises. The efficiency percentages at the end of the program were higher than at the beginning (p < 0.001). The cost of the program represented a saving of 67.89%. CONCLUSION: The new MIS training program improved the quality of learning in a safe environment, establishing common criteria among the different specialties and an improved use of resources.

INTRODUCCION: Las diferentes especialidades quirúrgicas de nuestro centro han usado los recursos de simulación y cirugía experimental para sus tareas de formación en cirugía mínimamente invasiva (CMI) de manera individualizada. Con este modelo de aprendizaje se detectó una gran dispersión de esfuerzos y gasto, por lo que se decidió crear un programa unificado basado en: aprendizaje compartido, sinergia entre especialidades, moderación del coste económico y uso racional de las instalaciones. OBJETIVO: Describir y evaluar nuestro programa de entrenamiento diseñado por consenso de cara a la consolidación de una estrategia de aprendizaje compartido que permita a nuestros residentes adquirir y perfeccionar habilidades quirúrgicas en CMI. MATERIAL Y METODOS: El programa consta de diferentes fases con complejidad creciente desarrolladas durante todo el periodo de formación especializada de forma continuada en laboratorio virtual y quirófano experimental. Los criterios de evaluación se basaron en criterios cuantificables: porcentaje de eficiencia y tiempo de realización de los ejercicios de McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) al inicio y final del programa. Se realizó también el estudio económico. RESULTADOS: Han completado el programa 20 residentes. Los tiempos medios demuestran una reducción significativa en cada uno de los ejercicios. Los porcentajes de eficiencia al final fueron mayores que al inicio del programa (p < 0,001). El coste del programa supuso un ahorro del 67,89%. CONCLUSION: El nuevo programa de entrenamiento en CMI mejoró la calidad de aprendizaje en un entorno seguro, estableciendo criterios comunes entre las diferentes especialidades y un mayor aprovechamiento de los recursos.

Programa de formación quirúrgica común: uniformidad en la calidad del aprendizaje / Common surgical training program: standardization of learning quality

Introducción: Las diferentes especialidades quirúrgicas de nuestrocentro han usado los recursos de simulación y cirugía experimentalpara sus tareas de formación en cirugía mínimamente invasiva (CMI)de manera individualizada. Con este modelo de aprendizaje se detectóuna gran dispersión de esfuerzos y gasto, por lo que se decidió crear unprograma unificado basado en: aprendizaje compartido, sinergia entreespecialidades, moderación del coste económico y uso racional de lasinstalaciones. Objetivo: Describir y evaluar nuestro programa de entrenamientodiseñado por consenso de cara a la consolidación de una estrategia deaprendizaje compartido que permita a nuestros residentes adquirir yperfeccionar habilidades quirúrgicas en CMI. Material y métodos: El programa consta de diferentes fases concomplejidad creciente desarrolladas durante todo el periodo de forma-ción especializada de forma continuada en laboratorio virtual y quiró-fano experimental. Los criterios de evaluación se basaron en criterioscuantificables: porcentaje de eficiencia y tiempo de realización de losejercicios de McGill Inanimate System for Training and Evaluation ofLaparoscopic Skills (MISTELS) al inicio y final del programa. Se realizótambién el estudio económico. Resultados: Han completado el programa 20 residentes. Los tiem-pos medios demuestran una reducción significativa en cada uno de losejercicios. Los porcentajes de eficiencia al final fueron mayores queal inicio del programa (p < 0,001). El coste del programa supuso unahorro del 67,89%. Conclusión: El nuevo programa de entrenamiento en CMI mejoróla calidad de aprendizaje en un entorno seguro, estableciendo criterioscomunes entre las diferentes especialidades y un mayor aprovechamientode los recursos.(AU)

Introduction: The various surgical specialties in our center haveused the simulation and experimental surgery resources availablefor their training tasks in minimally invasive surgery (MIS) in anindividualized manner. With this learning model, a great dispersionof effort and expense was observed, so it was decided to create aunified program based on the following: shared learning, synergyamong specialties, moderation of the economic cost, and rationaluse of the facilities. Objective: To describe and assess our consensually designed train-ing program in order to consolidate a shared learning strategy that willenable our residents to acquire and perfect surgical skills in MIS. Materials and methods: The program consists of various increas-ingly complex phases implemented on a continuous basis throughout theperiod of specialized training in the virtual laboratory and experimentaloperating room. The assessment methods were based on quantifiablecriteria: percentage of efficiency and completion time of the “McGillInanimate System for Training and Evaluation of Laparoscopic Skills”(MISTELS) exercises at the beginning and end of the program. Aneconomic study was also conducted. Results: 20 residents have completed the program. Mean timesshow a significant reduction in each of the exercises. The efficiencypercentages at the end of the program were higher than at the begin-ning (p < 0.001). The cost of the program represented a saving of67.89%.(AU)

Clinicopathologic features of frontotemporal dementia with progranulin sequence variation.

BACKGROUND: Frontotemporal lobar degeneration with ubiquitin-immunoreactive (ub-ir) inclusions (FTLD-U) has been associated with frontotemporal dementia (FTD) and ALS. Recently, mutations in Progranulin (PGRN), predicted to cause premature truncation of the PGRN coding sequence, were found in patients with inherited FTLD-U and ub-ir neuronal intranuclear inclusions (NII). OBJECTIVE: To describe clinical, pathologic, and genetic features of three FTD patients having either a family history of FTD (A.III.1 and B.II.1) or of ALS (C.III.1). METHODS: Patients underwent a single clinical assessment, MRI, and [(18)F]fluorodeoxyglucose PET brain scan. Neuropathologic examination and genetic analyses were carried out. RESULTS: Patients presented clinically with the behavioral variant of FTD. Language dysfunctions were marked with comprehension being particularly affected. Neuroimaging revealed frontotemporal atrophy and glucose hypometabolism, with predominant left-side involvement, in Patients A.III.1 and B.II.1. Subject C.III.1 displayed mild atrophy and symmetric anterior hypometabolism. All patients were neuropathologically diagnosed with FTLD-U. Ub-ir NII were noted in Patients A.III.1 and B.II.1 but were absent in Patient C.III.1. The following PGRN sequence variations were found: IVS6-2A-->G (A.III.1), R493X (B.II.1), and R433W (C.III.1). IVS6-2A-->G may lead to skipping of exon 7 with consequent frameshift of the coding sequence and premature termination of PGRN translation. CONCLUSIONS: We have found two PGRN mutations associated with FTD, in affected individuals who are members of families with possible autosomal dominant FTD. A third PGRN sequence variation (R433W) was found in an FTD patient with family history of ALS.

Intraspecific variation of Bothrops pubescens (cope, 1869) venom in Uruguay (serpentes: viperidae)

In Uruguay, there was no information about the variations degree in Bothrops pubescens venoms until the present work, in which we investigated intraspecific venom variation using polyacrylamide gel electrophoresis (SDS-PAGE). We found some differences in the venom protein profile; however, they were not related to the parameters studied (geographic distribution, weight, sex, and captivity time). Moreover, we distinguished two different groups in relation to band densities at 49 and 57 kDa. Specimens with predominant density in the 49kDa band tend to be predominantly females. Weight distribution in this group extended for all the range (150-1500 g) with an average weight of 720 g. The other group (57kDa predominant band) showed restricted weight range (150-400 g) with an average weight of 280 g. Cluster analysis was also performed. The variability observed in the venom profile probably corresponds to genetic variations.(AU)

Nasolacrimal stents in the treatment of epiphora: long-term results.

PURPOSE: Assessment of the long-term results achieved with use of nasolacrimal stents in the treatment of epiphora caused by obstruction of the lacrimal apparatus. The role of stents in treating this condition is evaluated. MATERIALS AND METHODS: From February 1997 to April 1999, a total of 89 procedures to insert nasolacrimal stents were performed in 77 patients (20 men, 57 women; mean age, 53 years). A total of 79 stents were successfully implanted, with 10 failures (11.2%). Postprocedural course was followed for 16-38 months (mean, 27 mo) by means of clinical examinations and/or periodic dacryocystography, with removal of occluded stents. On conclusion of the study in September 2000, dacryocystography was performed in all patients in whom stents were still in place. RESULTS: Of the 79 stents deployed, two were lost, two had to be excluded from the study, 45 (60%) ceased to function, and 30 (40%) remained patent. Median duration of stent patency of these 79 stents was 20 months. Mean time to occlusion was 9.2 months for all obstructed stents; 4.4 months for improperly placed stents (via a trajectory outside the normal lacrimal drainage apparatus) and 12.2 months for stents that appeared to have been inserted properly. Of the 45 occluded stents, 40 were removed and five were left in place. Upon removal, adherence of the stents to the lacrimal apparatus was frequently observed. CONCLUSIONS: The low patency rate and the difficulties encountered in removing nasolacrimal stents during the course of long-term placement calls into question the efficacy of this method as a definitive treatment for epiphora caused by obstruction of the lacrimal drainage system, although studies comparing this and other treatment modalities are needed. Assessment of temporary stent placement may be in order.

Transmission dynamics of Echinococcus granulosus, Taenia hydatigena and Taenia ovis in sheep in Uruguay.

A base-line survey was carried out on the transmission dynamics of Echinococcus granulosus, Taenia hydatigena and Taenia ovis in sheep in the Department of Florida, Uruguay. Mean life expectancy at birth of the sheep population in this Department was estimated at 3.5 and 4.8 years for male and female sheep, respectively. Both intensity and prevalence of E. granulosus infection increased with age providing no evidence that immunity was acquired in the population. This revealed that E. granulosus was only relatively stable and in an equilibrium endemic steady state with an estimate of the basic reproduction ratio (Ro) of about 1.2. The mature larval population in sheep was over-dispersed with parameter k, from fitting a negative binomial, being 0.199 and 0.556 in 42- and 54-month-old sheep, respectively. The mean number of cysts increased by 1.05 cysts per year and the infection pressure was calculated as 0.174 infections per year, implying that each infection consisted of 693.6 eggs to produce 6.03 cysts. Neither intensity nor prevalence of infection with T. hydatigena or T. ovis increased with age. This indicated that immunity was acquired to reinfection by both parasites and they were in an equilibrium hyperenedemic steady state with an estimated Ro of 4.2-5.8. Viability and fertility of E. granulosus, and viability of T. hydatigena cysts in the older age groups were low. The effects of the different transmission levels of the parasites on potential control strategies are discussed.

Microscopic diagnosis from frozen canine tissues.

Frozen tissues were studied microscopically to determine their value for diagnostic purposes. Sections were taken from lung, liver, kidney, small intestine, and brain of ten diseased dogs that died or were euthanatized. Some tissues were frozen, held for two or seven days, and then formalin-fixed. Tissues that were formalin-fixed immediately served as controls. Freezing changes such as transudate, cell shrinkage, fractures, hemolysis, and hematin formation were a nuisance, but usually did not prevent making a diagnosis. Viral inclusions, microfilaria, fibrosis, and intestinal bacteria remained distinct.

Effects of freezing and frozen storage on histological characteristics of canine tissues.

Frozen tissues were studied histologically to determine what changes were produced by freezing. Samples of brain, lung, liver, small intestine, and kidney from 20 stray dogs were treated in 3 ways: formalin fixation (control), frozen for 2 days plus formalin fixation, or frozen for 7 days plus formalin fixation. Major histological changes caused by freezing were loss of staining, extracellular fluid accumulation, cell shrinkage, fractures, hemolysis, and hematin formation. Lesser changes included loss of bronchial cilia, prominence of collagen in alveolar septa and meninges, and intracellular vacuolization of epithelial cells. Although these changes were annoying, adequate visualization of the tissues was usually possible.

Observación de la respuesta de los tejidos en ovinos vacunados con vacuna antiaftosa de adyuvante oleoso

Se realizó un estudio preliminar para determinar la reacción de los tejidos en ovinos vacunados con vacuna antiaftosa con adyuvante oleoso, según la vía de inoculación y dosis variables de vacuna. Con base en las observaciones de campo, inspección veterinaria en playa de faena y estudios histológicos se hicieron las siguientes observaciones: a) no existieron diferencias significativas en las reacciones macroscópicas y microscópicas entre las vacunas oleosas preparadas en emulsión simple o doble; b) al igual que lo ya demostrado en la especie bovina, este tipo de vacunas puede ser administrado por vía intramuscular utilizando el tercio anterior de la tabla de cuello como punto de elección; c) la vía intraperitoneal fue inocua y se sugiere la realización de futuros estudios conducentes a determinar si esta vía es aplicable en el campo, especialmente cuando se usa la emulsión doble; d) se deberá determinar la respuesta inmunitaria para la especie ovina, por las distinas vías y a diferentes dosis.

A preliminary study was conducted to determine tissue response in sheep vaccinated with oil-adjuvanted foot-and-mouth disease vaccine, according to route of inoculation and varying vaccine doses. Based on field observations, veterinary inspection at slaughterhouse and histological studies, the following observations were made: (a) no signigicant differences were observed in the macroscopic or microscopic reactions of the oil- adjuvanted vaccines prepared as primary or double emulsions; (b) as previously demonstrated in cattle, this type of vaccine can be administered intramuscularly in the forward third part of the flat of the neck; (c) the intraperitoneal route was innocuous, and it is suggested that future studies be conducted to ascertain whether this route is applicable in the field, especially when double emulsion is utilized; (d) the immune response should be determined in sheep for the different routes and varying doses.