[Ten-year survival after off-pump coronary artery bypass grafting compared with traditional bypass grafting]. / Cirugía de revascularización miocárdica: comparación de supervivencia a 10 años de la cirugía coronaria con y sin circulación extracorpórea mediante Propensity Score Matching.

BACKGROUND: Long-term outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) as an alternative to the traditional Coronary Artery Bypass Grafting (CABG) technique with cardiopulmonary bypass (CPB) are not well defined. AIM: To compare 10-year survival of isolated OPCAB versus CABG with CPB. MATERIAL AND METHODS: Analysis of information obtained from databases, clinical records and surgical protocols of patients treated with isolated CABG between January 2006 and November 2008 at a Regional Hospital. Of 658 isolated CABG, 192 (29.2%) were OPCAB and 466 (79.9%) CPB. Propensity Score Matching (PSM) was performed to compare both groups. After PSM, two groups of 192 cases were obtained. Mortality data was obtained from the Chilean public identification service. Ten-year survival was calculated and compared with Kaplan-Meier and log-rank methods. RESULTS: Follow-up data was obtained in all cases. No statistically significant differences were found when comparing 10-year survival between OPCAB versus CPB (78.6% and 80.2% respectively, p 0.720). There was also no statistical difference in cardiovascular death free survival (90.1% with CPB versus 89.1% OPCAB, p 0.737). Survival was comparable when analyzing subgroups with diabetes mellitus, left ventricular dysfunction or chronic kidney disease, among others. CONCLUSIONS: In our series, OPBAB has a comparable 10-year survival with CABG with CPB.

Cirugía de revascularización miocárdica: comparación de supervivencia a 10 años de la cirugía coronaria con y sin circulación extracorpórea mediante Propensity Score Matching / Ten-year survival after off-pump coronary artery bypass grafting compared with traditional bypass grafting

BACKGROUND: Long-term outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) as an alternative to the traditional Coronary Artery Bypass Grafting (CABG) technique with cardiopulmonary bypass (CPB) are not well defined. AIM: To compare 10-year survival of isolated OPCAB versus CABG with CPB. MATERIAL AND METHODS: Analysis of information obtained from databases, clinical records and surgical protocols of patients treated with isolated CABG between January 2006 and November 2008 at a Regional Hospital. Of 658 isolated CABG, 192 (29.2%) were OPCAB and 466 (79.9%) CPB. Propensity Score Matching (PSM) was performed to compare both groups. After PSM, two groups of 192 cases were obtained. Mortality data was obtained from the Chilean public identification service. Ten-year survival was calculated and compared with Kaplan-Meier and log-rank methods. RESULTS: Follow-up data was obtained in all cases. No statistically significant differences were found when comparing 10-year survival between OPCAB versus CPB (78.6% and 80.2% respectively, p 0.720). There was also no statistical difference in cardiovascular death free survival (90.1% with CPB versus 89.1% OPCAB, p 0.737). Survival was comparable when analyzing subgroups with diabetes mellitus, left ventricular dysfunction or chronic kidney disease, among others. CONCLUSIONS: In our series, OPBAB has a comparable 10-year survival with CABG with CPB.

Entrenamiento procedimental básico (EPROBA) en suturas para estudiantes de medicina durante pandemia por SARS-CoV-2 (COVID-19) / Suturing basic procedural skills training for medical students during COVID-19 pandemic

BACKGROUND: The adoption of sanitary measures due to the SARS-CoV-2 pandemic hampered teaching and learning methods in medicine. AIM: To communicate the results of a wound suture training workshop, based on the Basic Procedural Skills Training methodology and adapted to the pandemic context. MATERIAL AND METHODS: One hundred fourteen students were randomized in small groups due to sanitary measures and trained with a modification of the Basic Procedural Skills Training methodology. An informed consent was obtained from every student. The suturing skills were evaluated before and after the intervention with "The Objective Structured Assessment Of Technical Skills" (OSATS) instrument. The perception of the workshop and the implementation of the COVID-19 prevention measures were also evaluated. RESULTS: The students showed a statistically significant improvement after the intervention. In the OSATS verification list, the average score increased from 4.5 to 8.6 (p < 0.01). In the OSATS global scale, the average score increased from 13.0 to 25.3 (p < 0.01). The perception of the workshop and the prevention measures were well evaluated. CONCLUSIONS: Despite all the limitations of the pandemic context, we achieved a significant improvement after the intervention and a very good perception by the students.

Enfermedad coronaria: factores de riesgo y supervivencia a 10 años en la cirugía coronaria / Risk factors associated with 10-year survival after coronary artery bypass grafting

Background: Coronary artery bypass grafting (CABG) is the treatment of choice for a broad spectrum of patients with coronary disease. Aim: To describe global survival and factors associated with lower long-term survival in patients operated with isolated CABG. Material and Methods: Analysis of a cohort of patients who underwent CABG between January 2006 and December 2008 at a public hospital. The database and operation records of 1.003 cardiac surgeries were reviewed. Of these, an isolated CABG was performed in 658 patients aged 62 ± 9 years including 516 male (78%). Survival data were obtained from the Chilean Civil Registry Office and a complete ten-year follow up was accomplished. Survival was analyzed with Kaplan-Meier method with log-rank test and Cox regression. Results: Operative mortality occurred in 13 patients (2%). Survival at 1, 3, 5 and 10 years was 97, 94, 91 and 76%, respectively. One, 3, 5 and 10-year free of cardiovascular death survival was 98, 97, 95 y 89%, respectively. Factors associated with long-term survival were chronic kidney disease in hemodialysis (Hazard ratio (HR) 7.9; 95% confidence intervals (CI) 4.6-13.6), chronic obstructive pulmonary disease (HR 2.3; 95% CI 1.4-3.7), chronic arterial occlusive disease (HR 2.2; 95% CI 1.4-3.4) and diabetes mellitus (HR 1.9; 95% CI 1.4-2.6). According to EuroSCORE, 10-year survival was 86, 75 and 62% (p < 0.01) in low, medium and high-risk patients, respectively. Conclusions: These patients had a 10-year survival comparable to large international series. Groups associated with lower 10-year survival were identified.

Traumatismo torácico con lesión de grandes vasos del tórax: características, tratamiento y variables asociadas a mortalidad / Thoracic trauma with injury to the great vessels of the chest: characteristics, treatments and variables associated with mortality

Resumen Introducción: Las lesiones de grandes vasos del tórax por traumatismo torácico (TTLGV) son un grupo heterogéneo de lesiones con alta morbimortalidad que constituyen un 0,3-10% de los hallazgos en el traumatismo torácico (TT). Objetivos: Describir características, tratamientos y variables asociadas a mortalidad en pacientes hospitalizados con TTLGV. Material y Métodos: Estudio analítico-observacional. Período enero-1981 y diciembre-2020. Revisión de protocolos de TT prospectivos y fichas clínicas. Se clasificaron los TTLGV según American Association for the Surgery of Trauma (AAST), se calcularon índices de gravedad del traumatismo: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) y Trauma Injury Severity Score (TRISS). Se realizó análisis univariado y multivariado con cálculo de Odds Ratio (OR) para variables asociadas a mortalidad. Se usó SPSS25®, con pruebas UMann Whitney y chi-cuadrado, según corresponda. Resultados: de un total 4.577 TT, 97 (2,1%) cumplieron criterios de inclusión. Hombres: 81 (91,8%), edad promedio: 32,3 ± 14,8 años. TT penetrante: 65 (67,0%). Lesión de arterias axilo-subclavias en 39 (40,2%) y aorta torácica en 31 (32,0%) fueron las más frecuentes. Fueron AAST 5-6: 39 (40,2%). Tratamiento invasivo: 87 (89,7%), de éstos, en 20 (20,6%) reparación endovascular, 14 (14,4%) de aorta torácica. Cirugía abierta en 67 (69,1%). Mortalidad en 13 (13,4%), fueron variables independientes asociadas a mortalidad el shock al ingreso (OR 6,34) e ISS > 25 (OR 6,03). Conclusión: En nuestra serie, los TTLGV fueron más frecuentemente de vasos axilo-subclavios y aorta torácica. El tratamiento fue principalmente invasivo, siendo la cirugía abierta el más frecuente. Se identificaron variables asociadas a mortalidad.

Background: Thoracic great vessel injuries in thoracic trauma (TTGVI) are a heterogeneous group of injuries with high morbimortality that constituting 0.3-10% of the findings in thoracic trauma (TT). Aim: To describe characteristics, treatments and variables associated with mortality in hospitalized patients with TTGVI. Methods: Observational-analytical study. Period January-1981 and December-2020. Review of prospective TT protocols and clinical records. TTGVI were classified according to American Association for the Surgery of Trauma (AAST), trauma severity index were calculated: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) and Trauma Injury Severity Score (TRISS). Univariate and multi- variate analysis was performed with calculation of Odds Ratio (OR) for variables associated with mortality. SPSS25® was used, with U Mann Whitney and chi-squared tests, as appropriate. Results: From a total of 4.577 TT in the period, 97 (2.1%) met the inclusion criteria. Males: 81 (91.8%), mean age: 32.3 ± 14.8 years. Penetrating TT: 65 (67.0%). Axillary-subclavian artery lesions in 39 (40.2%) and thoracic aorta in 31 (32.0%) were more frequent. AAST 5-6: 39 (40.2%). Invasive treatment: 87 (89.7%), of these, in 20 (20.6%) endovascular repair, 14 (14.4%) of thoracic aorta. Open surgery in 67 (69.1%). Mortality in 13 (13.4%), shock on admission was independently associated with mortality (OR 6.34) and ISS > 25 (OR 6.03). Conclusión: In our series, TTGVI were more frequent in axillary-subclavian vessels and thoracic aorta. Treatment was mainly invasive, with open surgery being the most frequent. Variables associated with mortality were identified.

[Lung cancer at a Chilean public hospital]. / Cáncer pulmonar: caracterización, estadificación y supervivencia en una cohorte de una década en un hospital del sistema público de salud de Chile.

BACKGROUND: Lung cancer is the world's leading cause of cancer death. AIM: To describe the clinical, staging and survival characteristics of lung cancer in a public Chilean regional hospital. MATERIAL AND METHODS: Analysis of a prospective database of a thoracic surgery service, retrieving histologically confirmed lung cancer cases from January 2010 to December 2019 and reviewing their medical records. Cases were re-staged by the TNM-8 system and variables were compared between periods 2010-2014 and 2015-2019. RESULTS: We retrieved 551 lung cancer cases, 333 (60 %) men, with a mean age of 65 years. Distant metastases were found in 72% of cases (excluding lymphatic metastases). Of the non-small cell lung cancers (NSCLC), 50 (10%) cases were in stage I, 18 (4%) in stage II, 81 (16%) in stage III and 347 (70%) in stage IV. Global five-year survival was 18%, 20% for NSCLC, 71% for excised NSCLC, 8% for non-excised NSCLC, 88% for stage I and 92% for subgroup IA. Resective surgery was performed in 81 (14%) cases. When comparing 2010-2014 and 2015-2019 periods, the frequency of resective surgery increased from 7% to 20%. CONCLUSIONS: The diagnosis of lung cancer was frequently made in advanced stages. There was a significant increase in early diagnosis and frequency of surgeries with curative intent in the second observation period.

Traumatismo de grandes vasos del tórax: tratamiento quirúrgico con soporte de circulación extracorpórea / Injury of the great vessels of the chest: surgical treatment with cardiopulmonary bypass support: clinical cases

Resumen Objetivo: Presentar dos casos en que se empleó como soporte la circulación extracorpórea (CEC) durante cirugía por traumatismo torácico con lesión de grandes vasos del tórax (TTLGV). Materiales y Método: Se presentan dos casos con TTLGV en que se empleó cirugía con CEC. Resultados: Caso 1; hombre de 31 años con TTLGV por cuerpo extraño (tubo pleural) intracavitario del tronco de la arteria pulmonar izquierda, con entrada a través de parénquima pulmonar, en que se realizó cirugía abierta para retiro de cuerpo extraño más toractotomía pulmonar utilizando CEC como soporte. Caso 2; hombre de 21 años con TTLGV contuso y lesión de aorta en unión sino tubular, en que se realizó cirugía abierta y reemplazo de aorta ascendente con prótesis y uso CEC como soporte. Discusión: El uso de CEC como soporte es una alternativa para sustituir la función cardíaca y/o pulmonar durante cirugías excepcionales de reparación de TTLGV. Conclusión: El uso de técnicas de asistencia circulatoria como soporte durante la cirugía de reparación de TTLGV ocurre en casos muy seleccionados, siendo una alternativa ante lesiones particularmente complejas.

Aim: To present two cases of thoracic trauma with great vessel injury (TTGVI) surgeries where extracorporeal circulation (ECC) was employed. Materials and Method: Two TTGVI cases are presented and ECC during surgery was used in both. Results: Case 1; 31-year-old man with TTGVI due to an intracavitary foreign body (pleural tube) in the left pulmonary artery trunk, which entered through lung parenchyma. An open surgery was performed to remove the foreign body with pulmonary tractotomy using ECC as support. Case 2; 21-year-old man with blunt TTGVI and aortic injury at sinotubular junction. An open surgery with ascending aorta prosthesis replacement was performed, using ECC as support. Discussion: The use of ECC as support is an alternative to replace cardiac and/or pulmonary function during exceptional TTGVI reparation surgeries. Conclusión: The use of circulation assist techniques as support during TTGVI repair surgery occurs in highly selected cases, being an alternative to face very complex injuries.

Hidatidosis pulmonar: comparación de los resultados de la cirugía con y sin capitonaje mediante Propensity Score Matching / Pulmonary hydatidosis: comparison results of surgery with capitonnage versus surgery without capitonnage using Propensity Score Matching

Resumen Introducción: El tratamiento de elección del Quiste Hidatídico Pulmonar (QHP) es la resección quirúrgica. Actualmente, existe controversia sobre la superioridad de la cirugía con capitonaje (CC) versus la cirugía sin capitonaje (SC). Objetivo: Comparar los resultados de la cirugía conservadora CC y SC mediante Propensity Score Matching (PSM). Materiales y Método: Se realizó un estudio analítico retrospectivo de los pacientes con QHP tratados quirúrgicamente en el Hospital Guillermo Grant Benavente, Concepción, Chile; entre enero-1995 y diciembre-2018. Se realizó un PSM con una relación 1:1 entre los pacientes operados con la técnica CC y SC. Posterior al PSM se balancearon las características basales. Resultados: Total 205 episodios de QHP en el período. Se realizó cirugía conservadora en 165 casos, 101 CC y 64 SC. Posterior al emparejamiento se obtuvieron 53 pacientes operados CC y 53 SC. No se observaron diferencias significativas en la presencia de fuga aérea persistente (CC = 9,4%; SC = 11,3%, p 0,75), empiema (CC = 3,8%; SC = 0%, p 0,49), días con pleurotomía (CC = 9,1 ± 8,9; SC 10,1 ± 10,7, p 0,39, mediana 6 versus 6 días, respectivamente), ni días de estadía posoperatoria (CC = 10,4 ± 9,0; SC = 11,7 ± 11,9, p 0,22, mediana 7 versus 7 días, respectivamente). Conclusiones: La cirugía SC demostró resultados comparables a la técnica CC en el tratamiento quirúrgico conservador del QHP.

Background: The treatment of choice for Pulmonary Hydatid Cys (PHC) is surgical resection. There is currently controversy about the superiority of surgery with capitonage (SC) versus surgery without it (SWC). Aim: To compare the results of conservative surgery with capitonnage and versus surgery without capitonnage using Propensity Score Matching (PSM). Materials and Method: A retrospective analytical study was carried out with patients with PHC treated surgically at the Guillermo Grant Benavente Hospital, Concepción, Chile, between January-1995 and December-2018. A PSM was performed with a 1:1 ratio. Results: Conservative surgery was done in 165 cases, 101 SC and 64 SWC. After matching, 53 SC and 53 SWC operated patients were obtained. No significant differences were observed in the presence of persistent air leak (9.4% vs11.3%, SC vs SWC respectively, p 0.75), empyema (3.8% vs 0%, p 0.49), days with pleurotomy (9.1 ± 8.9 vs 10.1 ± 10.7, p 0.39), nor days of postoperative stay (10.4 ± 9.0 vs 11.7 ± 11.9, p 0.22). Conclusión: The SWC demonstrated comparable results to the SC technique in the conservative surgical treatment of PHC.

Cirugías por traumatismo torácico: caracterización y variables asociadas a mortalidad / Thoracic trauma surgery: indications, findings and mortality associated variables

Resumen Introducción: El traumatismo torácico (TT) es la causa de aproximadamente un cuarto de las muertes por traumatismos. Los pacientes tratados con cirugía por traumatismo torácico (CTT) presentan un amplio espectro de características y pronósticos. Objetivos: Describir características clínicas, indicaciones, temporalidad, morbilidad, mortalidad y las variables asociadas a mortalidad en pacientes con CTT. Materiales y Método: Estudio observacional de pacientes tratados con CTT, período enero-1981 a diciembre-2019. Revisión de protocolos prospectivos de TT y base de datos. Se realizó regresión logística para variables asociadas a mortalidad. Se utilizó SPSS25® con prueba chi-cuadrado para comparar clasificación, tipo de TT y su distribución temporal, considerando significativo p < 0,05. Resultados: En total 808 casos (18,2%) de 4.448 TT requirieron CTT. Fueron hombres 767 (94,9%) y la edad promedio fue 31,5 ± 13,8 años. El traumatismo fue penetrante y por arma blanca en la mayoría de los casos. Fueron politraumatizados 164 (20,3%). La cirugía fue urgente en 474 (58,7%), precoz en 41 (5,0%) y diferida en 293 (36,3%) casos. La mortalidad global fue de 6,7% y fue significativamente mayor en TT contusos, politraumatizados y en cirugía urgente. La mortalidad fue 9,7% en CTT urgente, 4,9% en precoz y 2,0% en diferida (p < 0,001). Se observaron variables independientes asociadas a mortalidad. Conclusión: En nuestra serie, las CTT se realizaron principalmente en hombres jóvenes con TT penetrantes. Correspondieron a un grupo heterogéneo en cuanto a las indicaciones, hallazgos y lesiones intratorácicas y/o asociadas. Múltiples variables demostraron influir significativamente en la mortalidad de los pacientes tratados con CTT.

Background: Thoracic Trauma (TT) is the cause of approximately a quarter of trauma deaths. The patients who undergo Thoracic Trauma Surgery (TTS) present a wide spectrum of characteristics and prognosis. Aim: To describe clinical characteristics, indications, temporality, morbidity, mortality and mortality associated variables in TTS patients. Materials and Method: Observational study of TT hospitalized patients, period January-1981 to December-2019. A review of operation notes and database was done. A logistic regression for mortality associated variables was made. To compare classification, type of TT and its temporal distribution, SPSS25® with chi-square test was used, considering significant p < 0.05. Results: A total of 808 (18.2%) of 4.448 TT patients required TTS, 767 (94.9%) were men with average age: 31.5 ± 13.8. The trauma was penetrating trauma due to a stab in most cases, 164 (20.3%) were polytraumatized. The surgery was urgent in 474 (58.7%), early in 41 (5.0%) and delayed in 293 (36.3%) cases. The global mortality was 6.7% and was significantly higher in the blunt TT, polytrauma, urgent and early surgery patients. Mortality in urgent TTS was 9.7%, early 4.9% and 2.0% in delayed (p < 0.001). Independent variables associated with mortality were observed. Conclusions: In our series, TTS were performed mainly in young men with penetrating TT. The group was heterogeneous regarding surgical indications, findings and intrathoracic or associated injuries. Multiple variables showed to influence significantly on mortality in patients who underwent TTS.

Cáncer pulmonar: caracterización, estadificación y supervivencia en una cohorte de una década en un hospital del sistema público de salud de Chile / Lung cancer at a Chilean public hospital

Background: Lung cancer is the world's leading cause of cancer death. Aim: To describe the clinical, staging and survival characteristics of lung cancer in a public Chilean regional hospital. Material and Methods: Analysis of a prospective database of a thoracic surgery service, retrieving histologically confirmed lung cancer cases from January 2010 to December 2019 and reviewing their medical records. Cases were re-staged by the TNM-8 system and variables were compared between periods 2010-2014 and 2015-2019. Results: We retrieved 551 lung cancer cases, 333 (60 %) men, with a mean age of 65 years. Distant metastases were found in 72% of cases (excluding lymphatic metastases). Of the non-small cell lung cancers (NSCLC), 50 (10%) cases were in stage I, 18 (4%) in stage II, 81 (16%) in stage III and 347 (70%) in stage IV. Global five-year survival was 18%, 20% for NSCLC, 71% for excised NSCLC, 8% for non-excised NSCLC, 88% for stage I and 92% for subgroup IA. Resective surgery was performed in 81 (14%) cases. When comparing 2010-2014 and 2015-2019 periods, the frequency of resective surgery increased from 7% to 20%. Conclusions: The diagnosis of lung cancer was frequently made in advanced stages. There was a significant increase in early diagnosis and frequency of surgeries with curative intent in the second observation period.

[Suturing basic procedural skills training for medical students during COVID-19 pandemic]. / Entrenamiento procedimental básico (EPROBA) en suturas para estudiantes de medicina durante pandemia por SARS-CoV-2 (COVID-19).

BACKGROUND: The adoption of sanitary measures due to the SARS-CoV-2 pandemic hampered teaching and learning methods in medicine. AIM: To communicate the results of a wound suture training workshop, based on the Basic Procedural Skills Training methodology and adapted to the pandemic context. MATERIAL AND METHODS: One hundred fourteen students were randomized in small groups due to sanitary measures and trained with a modification of the Basic Procedural Skills Training methodology. An informed consent was obtained from every student. The suturing skills were evaluated before and after the intervention with "The Objective Structured Assessment Of Technical Skills" (OSATS) instrument. The perception of the workshop and the implementation of the COVID-19 prevention measures were also evaluated. RESULTS: The students showed a statistically significant improvement after the intervention. In the OSATS verification list, the average score increased from 4.5 to 8.6 (p < 0.01). In the OSATS global scale, the average score increased from 13.0 to 25.3 (p < 0.01). The perception of the workshop and the prevention measures were well evaluated. CONCLUSIONS: Despite all the limitations of the pandemic context, we achieved a significant improvement after the intervention and a very good perception by the students.

[Risk factors associated with 10-year survival after coronary artery bypass grafting]. / Enfermedad coronaria: factores de riesgo y supervivencia a 10 años en la cirugía coronaria.

BACKGROUND: Coronary artery bypass grafting (CABG) is the treatment of choice for a broad spectrum of patients with coronary disease. AIM: To describe global survival and factors associated with lower long-term survival in patients operated with isolated CABG. MATERIAL AND METHODS: Analysis of a cohort of patients who underwent CABG between January 2006 and December 2008 at a public hospital. The database and operation records of 1.003 cardiac surgeries were reviewed. Of these, an isolated CABG was performed in 658 patients aged 62 ± 9 years including 516 male (78%). Survival data were obtained from the Chilean Civil Registry Office and a complete ten-year follow up was accomplished. Survival was analyzed with Kaplan-Meier method with log-rank test and Cox regression. RESULTS: Operative mortality occurred in 13 patients (2%). Survival at 1, 3, 5 and 10 years was 97, 94, 91 and 76%, respectively. One, 3, 5 and 10-year free of cardiovascular death survival was 98, 97, 95 y 89%, respectively. Factors associated with long-term survival were chronic kidney disease in hemodialysis (Hazard ratio (HR) 7.9; 95% confidence intervals (CI) 4.6-13.6), chronic obstructive pulmonary disease (HR 2.3; 95% CI 1.4-3.7), chronic arterial occlusive disease (HR 2.2; 95% CI 1.4-3.4) and diabetes mellitus (HR 1.9; 95% CI 1.4-2.6). According to EuroSCORE, 10-year survival was 86, 75 and 62% (p < 0.01) in low, medium and high-risk patients, respectively. CONCLUSIONS: These patients had a 10-year survival comparable to large international series. Groups associated with lower 10-year survival were identified.

Reconstrucción de válvula aórtica con pericardio autólogo según técnica de Ozaki

Prosthetic valve replacement is the standard treatment for aortic valvulopathy. Due to the structural valve deterioration of biological prosthesis and the anticoagulation requirements of mechanical valves, the repair of aortic valve disease is receiving more attention in recent years. The Ozaki technique consists in the reconstruction of a trileaflet valve using autologous pericardium. We report our first two cases of successful reconstruction of the aortic valve using this technique with 12-month echocardiographic and 24-month clinical follow up.

Mortalidad en hospitalizados con traumatismo torácico: variables asociadas, causas y distribución temporal / Associated variables, causes and time distribution of mortality in thoracic trauma patients

Resumen Introducción: Los traumatismos están entre las diez principales causas de muerte a nivel mundial y son la primera en jóvenes. El traumatismo torácico (TT) está presente en un alto porcentaje de las muertes por traumatismos y es la segunda causa de muerte después del traumatismo encefalocraneano. Objetivos: Analizar las variables asociadas a mortalidad, las causas principales y la distribución temporal de la mortalidad en hospitalizados fallecidos con TT. Materiales y Método: Estudio observacional de hospitalizados con TT, período enero de 1981 a diciembre de 2018. Revisión de protocolos prospectivos de TT y base de datos. Se consignaron las causas de muerte sindromáticas principales y se realizó una regresión logística para variables asociadas a mortalidad. Se utilizó SPSS25® con pruebas chi-cuadrado para comparar clasificación, tipo de TT y su distribución temporal, considerando significativo p < 0,05. Resultados: Total 4.297 TT, mortalidad global de 120 (2,8%) casos. Las principales variables independientes asociadas a mortalidad fueron el deterioro fisiológico al ingreso, el hemotórax masivo y el TT por arma de fuego. La principal causa de muerte fue el shock hipovolémico, con diferencias significativas según tipo de TT en las primeras 4 y 24 horas. En la distribución temporal se observó que las muertes con TT penetrante y aislado fueron más precoces y no se evidenció un nuevo peak en la mortalidad luego de la primera semana. Conclusiones: Se observaron variables independientes asociadas a mortalidad en hospitalizados con TT, siendo el deterioro fisiológico al ingreso el factor más importante. Además, existen diferencias significativas en las causas de muerte y distribución temporal de la mortalidad entre diferentes subgrupos de hospitalizados con TT.

Background: Trauma is one of the ten leading causes of death worldwide and the first among the youth. Thoracic trauma (TT) is present in a high percentage of deaths due to trauma and is the second leading cause of death after traumatic brain injury. Aim: To analyze the mortality associated variables, major causes and temporal distribution of mortality among dead hospitalized patients with TT. Materials and Method: Observational study in hospitalized patients with TT, period January 1981 to December 2018. Review of prospective TT protocols and data base. Major syndromic causes of death were recorded and a logistic regression for variables associated with mortality was made. SPSS25® with chi-quadrat tests was used to compare classification, type of TT and temporal distribution. A p value < 0,05 was considered significant. Results: Total 4.297 TT and global mortality was 120 (2,8%) cases. The main independent variables associated with mortality were the physiological decline upon admission, massive hemothorax and TT by firearms. The leading cause of death was hypovolemic shock, with significant differences according to the type of TT in the first 4 and 24 hours. In the temporal distribution was observed that, the deaths with penetrating and isolated TT were earlier and that there was no second peak of mortality following the first week. Conclusions: Independent variables associated with mortality were observed among hospitalized patients with TT, being physiological deterioration the most important factor. Besides, there are significant differences in the death causes and temporal distribution of mortality among the different subgroups of hospitalized patients with TT.

Traumatismo torácico: análisis de hospitalizaciones según grupo etario / Thoracic trauma: analysis of hospitalizations among different age-groups

Resumen Introducción: El traumatismo es la primera causa de muerte en adolescentes y la quinta en el adulto mayor. El traumatismo torácico (TT) posee características particulares en diferentes grupos de edad. Objetivos: Analizar características clínicas, índice de gravedad de traumatismo (IGT) y mortalidad en hospitalizados por TT según grupo etario. Materiales y Método: Estudio descriptivo de hospitalizaciones por TT, período enero de 1981 a diciembre de 2018. Revisión de protocolos prospectivos de TT y base de datos. Se definió grupo etario según Organización Mundial de la Salud (Adolescente: 10-19 años; Adulto Joven: 20-44 años; Adulto Maduro 45-59 años; Adulto Mayor: ≥ 60 años). Se comparó clasificación, mecanismo, agente, tratamiento, IGT, Trauma Injury Severity Score (TRISS) y mortalidad del TT según grupo etario. Se utilizó SPSS25® con pruebas chi-cuadrado y ANOVA, considerando significativo p < 0,05. Resultados: Total 4.297 TT. Grupo etario Adolescente: 608 (14,1%); Adulto Joven: 2.544 (59,2%); Adulto Maduro: 601 (14,0%); Adulto Mayor: 544 (12,7%). Se observó disminución progresiva y significativa en TT penetrante, por agresión y del TT por arma blanca desde grupo etario Adolescente hasta Adulto Mayor. En Adulto Joven predominó tratamiento invasivo: cirugía 541 (21,2%) y en Adulto Maduro el TT con lesiones asociadas 215 (35,8%), p < 0,05. Según grupo etario, se observaron diferencias significativas en TRISS y en mortalidad. La mortalidad fue 1,6%; 2,5%; 3,3%; 5,0%, según grupo etario respectivamente (p < 0,05). Conclusiones: Existen diferencias estadísticamente significativas en las características clínicas, IGT y mortalidad del TT al comparar distintos grupos etarios. La edad es uno de los factores que determina el pronóstico de pacientes hospitalizados por TT.

Background: Trauma is the leading death cause among adolescents and the fifth in the elderly. Thoracic trauma (TT) has particular characteristics in different age-groups. Aim: To analyze clinical characteristics, trauma severity indices (TSI) and mortality in patients hospitalized for TT among different age-groups. Materials and Method: Descriptive study of patients hospitalized for TT between January-1981 and December-2018. Prospective TT surgical operation notes and data base were reviewed. Age-groups were determined according to the World Health Organization (Adolescent: 10-19 years; Young Adult: 20-44 years; Mature Adult: 45-59 years; Elderly > 60 years). TT classification, mechanism, agent, treatment, TSI, Trauma Injury Severity Score (TRISS) and mortality were compared among age-groups. SPSS25® with chi-square test and ANOVA were used, considering p < 0.05 significant. Results: Total 4.297 TT. Adolescent age-group: 608 (14.1%); Young Adult: 2,544 (59.2%); Mature Adult: 601 (14.0%); Elderly: 544 (12.7%). Was observed a progressive and significant decrease of penetrating TT, aggression-caused and bladed weapon-caused TT from Adolescent to Elderly. In Young Adult the invasive treatment predominant: surgery 541 (21.2%), whereas in Mature Adult TT with associated injuries 215 (35.8%), p < 0.05. Differences in TRISS and mortality 1.6%; 2.5%; 3.4%; 5.0% (p < 0.05) were observed among age-groups, respectively. Conclusions: There are statistical significant differences in clinical characteristics, TSI and mortality when comparing TT by age group. Age is an important factor determining the outcome in TT hospitalized patients.

Evolución del traumatismo penetrante cardíaco operado / Penetrating cardiac injury: evolution of characteristics, severity and mortality in surgery treated patients

Resumen Introducción: El traumatismo penetrante cardíaco (TPC) es una lesión poco frecuente y con alta morbilidad y mortalidad. Objetivo: Analizar la evolución de características clínicas, anatómicas, gravedad, morbilidad y mortalidad de pacientes operados por TPC. Materiales y Métodos: Estudio analítico de pacientes tratados quirúrgicamente por TPC en Hospital Clínico Regional "Dr. Guillermo Grant Benavente", Concepción, Chile. Se analizaron los periodos: enero-1990 a diciembre-2004 y enero-2005 a diciembre-2019. Se comparó: sexo, edad, lesiones asociadas, agente y mecanismo del traumatismo, comportamiento fisiopatológico, ubicación anatómica de la lesión, clasificaciones del traumatismo cardíaco Attar, Saadia y OIS-AAST, IGT (índices de gravedad del traumatismo): ISS, RTS-T y TRISS, morbilidad y mortalidad según periodos. Se realizó análisis estadístico con SPSS25®, se utilizaron las pruebas chi-cuadrado, exacta de Fisher y Mann-Whitney. Se consideró significativo un valor p < 0,05. Resultados: Total 235 TPC, 112 en el primer periodo y 123 en el segundo. Mecanismo arma blanca en 96 (85,7%) y 104 (84,6%) según periodos. En el segundo periodo se observó un aumento de lesiones extratorácicas asociadas, paro cardiorrespiratorio y lesión de ubicación izquierda. Las clasificaciones del traumatismo cardíaco y los IGT ISS, RTS-T y TRISS mostraron mayor gravedad y probabilidad de muerte en los pacientes del segundo periodo. La mortalidad no mostró diferencias: 14 (12,5%) y 14 (11,4%) según periodos (p = 0,792). Discusión: En nuestra serie los pacientes tratados por TPC han evolucionado hacia un perfil de mayor gravedad tanto en parámetros fisiológicos como anatómicos. La mortalidad se ha mantenido estable a través del tiempo.

Background: Penetrating cardiac injury (PCI) is a rare injury with high morbidity and mortality. Aim: To analyze the evolution of clinical and anatomical characteristics, severity, morbidity and mortality of patients operated on by PCI. Materials and Methods: Analytical study of patients surgically treated for PCI at the "Guillermo Grant Benavente" Regional Clinical Hospital, Concepción, Chile. Two periods were analyzed: January-1990 to December-2004 and January-2005 to December-2019. Sex, age, associated injuries, trauma agent and mechanism, pathophysiological behavior, anatomic location of the injury, classifications of cardiac trauma: Attar, Saadia and OIS-AAST, TSI (trauma severity indices): ISS, RTS-T and TRISS, morbidity and mortality were compared according to periods. Statistical analysis was performed with SPSS25®, the chi-square, Fisher exact and Mann-Whitney tests were used. A p value < 0.05 was considered significant. Results: Total 235 PCI, 112 in the first period and 123 in the second. Stab as mechanism in 96 (85.7%) and 104 (84.6%) according to periods. An increase in associated extra thoracic injuries, cardiorespiratory arrest, and injury to the left location were observed in the second period. The cardiac trauma classifications and the TSI ISS, RTS-T and TRISS showed greater severity and probability of death in the second period patients. Mortality did not show differences: 14 (12.5%) and 14 (11.4%) according to periods, p = 0.792. Discussion: In our series, patients treated with PCI have evolved towards a more severity profile in both, physiological and anatomical parameters. Mortality has been stable over time.

Secuestro pulmonar: caracterización y tratamiento en pacientes adultos y pediátricos / Pulmonary sequestration: characteristics and treatment in adult and pediatric patients

Resumen Introducción: El secuestro pulmonar (SP) es una malformación congénita caracterizada por tejido pulmonar con vascularización de una arteria sistémica anómala. Objetivo: Analizar las características y tratamiento de pacientes adultos y pediátricos con secuestro pulmonar. Materiales y Método: Estudio descriptivo transversal. Periodo: enero de 1988 a diciembre de 2018. La información se obtuvo de fichas clínicas y registros de anatomía patológica. Se describen edad, sexo, características clínicas, diagnóstico, tratamiento quirúrgico y hallazgos anatomopatológicos. Se realizó análisis estadístico mediante SPSS25® y se usó la prueba Mann-Whitney y X2, considerándose significativo p < 0,05. Resultados: Total 33 pacientes, 25 (75,8%) mujeres. Edad promedio 30,2 años, rango: 0-68. Adultos 23 (69,7%) pacientes y pediátricos (< 15 años) 10 (30,3%) pacientes. La presentación clínica fue sintomatología pulmonar en 23 (69,7%) casos y 9 (27,3%) eran asintomáticos. Tres (9,1%) presentaron malformación congénita asociada. Diagnóstico preoperatorio en 15 (45,5%) pacientes. La ubicación más frecuente fue lóbulo inferior izquierdo. El tipo intralobar fue el más frecuente en 23 (69,7%) casos. La cirugía más frecuente fue la lobectomía con identificación y ligadura del vaso sistémico. El vaso aberrante se originó en aorta torácica en 27 (81,8%) casos e infradiafragmático (no precisado) en 3 (9,1%) casos. Vaso único en 26 (78,8%) y doble en 5 (15,2%) casos. No hubo mortalidad. Existen diferencias en las características entre los secuestros en pacientes adultos y pediátricos. Discusión y Conclusión: Los SP son infrecuentes, se presentan principalmente en adultos jóvenes como neumopatías a repetición, se distinguen diferencias en las características entre los pacientes adultos y pediátricos, y tienen excelente pronóstico posoperatorio.

Background: Pulmonary sequestration (PS) is a congenital malformation characterized by lung tissue with vascularization from anomalous systemic arteries. Aim: To analyze characteristics and treatment of adult and pediatric patients with pulmonary sequestration. Materials and Method: Transversal descriptive study. Period: January-1988 to December-2018. Information was obtained from clinical files and pathological anatomy records. Age, sex, clinical characteristics, diagnosis, surgical treatment and pathological findings are described. Statistical analysis was performed using SPSS25® and the Mann-Whitney and Chi square test were used, considering p < 0.05 to be significant. Results: Total 33 patients, 25 (75.8%) women. Average age 30.2 years, range: 0-68. Adults 23 (69.7%) patients and pediatric (< 15 years) 10 (30.3%) patients. The clinical presentation was pulmonary symptoms in 23 (69.7%) cases and 9 (27.3%) were asymptomatic. Three (9.1%) presented another congenital malformation. Preoperative diagnosis in 15 (48.4%) patients. The most frequent location was the left lower lobe. The intralobar type was the most frequent: 23 (69.7%) cases. The most frequent surgery was lobectomy with identification and ligation of the systemic vessel. The systemic vessel originated in the thoracic aorta in 27 (81.8%) cases and infradiaphragmatic (not specified) in 3 (9.1%) cases. Single vessel in 26 (78.8%) and double in 5 (15.2%) cases. There was no mortality. Differences were found in characteristics between adult and pediatric patients. Conclusion: SP are infrequent, they mostly appear in young adults as recurrent lung diseases, differences in characteristics are distinguished between adult and pediatric patients and they have an excellent postoperative prognosis.

Rol de conocimientos previos en los resultados de un programa de entrenamiento en sutura de heridas para estudiantes de medicina mediante metodología EPROBA / Role of previous knowledge in the results of a training program in wound suturing for medical students using EPROBA methodology

Resumen Objetivo: Comparar la adquisición de habilidades quirúrgicas básicas en estudiantes de medicina según el tipo de instrucción teórico-práctica recibida previo a un taller estandarizado de sutura de heridas. Materiales y Método: Estudio cuasiexperimental antes-después para estudiantes de cuarto año durante el 2018. Se realizó taller de sutura de heridas aplicado en modelo biológico (pata de cerdo), previo consentimiento informado y aprobación Comité Ético Científico. Mediante instrumento "The Objective Structured Assessment Of Technical Skills" (OSATS) se evaluó técnica de sutura antes y después del entrenamiento. Se dividió a los participantes según conocimientos previos al taller: Grupo A: recibió instrucción teórico-práctica en pacientes in vivo. Grupo B: recibió instrucción teórico-práctica en modelos de simulación. Grupo C: sin conocimientos previos en suturas. Se evaluó percepción de estudiantes mediante encuesta validada. Se comparó puntaje OSATS antes-después del taller y encuesta de percepción según grupo, utilizando SPSS24® y ANOVA. Se consideró significativo p < 0,05. Resultados: Se evaluaron 124 estudiantes. Grupo A: 17 (13,7%); Grupo B: 38 (30,7%); Grupo C: 69 (55,6%) respectivamente. Existió diferencia en puntaje OSATS de ingreso al taller Grupo A: 19,4 ± 4,9; Grupo B: 13,7 ± 6,3; Grupo C: 11,1 ± 4,5 (p < 0,05). Puntaje OSATS finalizada la intervención Grupo A: 28,8 ± 1,5; Grupo B: 28,0 ± 1,9; Grupo C: 27,9 ± 2,2 (p = 0,48), sin diferencia significativa. La intervención fue bien percibida, sin diferencias significativas entre grupos. Discusión: El resultado de evaluación OSATS finalizado el taller es independiente de experiencias, instrucción teórico-práctica o conocimientos previos a la intervención. Conclusión: Los programas de entrenamiento con evaluación estandarizada pueden equiparar los resultados entre estudiantes con diferentes conocimientos previos.

Aim: To compare the learning of basic surgical skills among medical students according to the type of theoretical and practical instruction they had prior to a standardized wound suturing workshop. Materials and Method: Quasi-experimental before and after study intended to fourth year students for the 2018. The wound suturing workshop was carried out with help of a biological model (pork leg), prior to an informed consent and the approval of the Ethics Committee. The suturing skills were evaluated by the tool "The Objective Structured Assessment Of Technical Skills" (OSATS) before and after the training. All of the participating students were sorted in groups by their previous surgical knowledge: Group A: received theoretical and practical instruction in patients. Group B: received theoretical and practical instruction in simulation models. Group C: without previous suturing knowledge. The students perception was evaluated by a validated survey. The OSATS score before and after the workshop and the perception survey were compared between the groups, using SPSS24® and ANOVA. p < 0,05 was considered significant. Results: 124 students were evaluated. Group A: 17 (13.7%); Group B: 38 (30.7%); Group C: 69 (55.6%) accordingly. There was a OSATS score difference before the workshop Group A: 19.4 ± 4,9; Group B: 13.7 ± 6.3; Group C: 11.1 ± 4.5 (p < 0.05). OSATS score after the intervention Group A: 28.8 ± 1.5; Group B: 28.0 ± 1.9; Group C: 27.9 ± 2.2 (p = 0.48), without a significant difference. The intervention was well perceived, without significant differences among the groups. Discussion: The OSATS score post workshop is independent of experiences, theoretical and practical instruction or previous knowledge. Conclusion: Training programs with standardized evaluation can even out the results among students with different previous knowledge.

[Reconstruction of aortic valve using Ozaki technique. Report of two cases]. / Reconstrucción de válvula aórtica con pericardio autólogo según técnica de Ozaki.

Prosthetic valve replacement is the standard treatment for aortic valvulopathy. Due to the structural valve deterioration of biological prosthesis and the anticoagulation requirements of mechanical valves, the repair of aortic valve disease is receiving more attention in recent years. The Ozaki technique consists in the reconstruction of a trileaflet valve using autologous pericardium. We report our first two cases of successful reconstruction of the aortic valve using this technique with 12-month echocardiographic and 24-month clinical follow up.

Entrenamiento de competencias procedimentales quirúrgicas básicas en estudiantes de Medicina mediante un modelo de simulación (EPROBA) / Training of basic surgical procedural skills in medical students using a simulation model (EPROBA)

Resumen Introducción: Los modelos de simulación otorgan entornos controlados para la práctica y la retroalimentación por parte de un tutor. Frente a una primera experiencia, nuestro grupo implementó un modelo simplificado y reproducible para el entrenamiento de habilidades quirúrgicas básicas. Objetivo: Comunicar los resultados de un taller de entrenamiento basado en simulación para la adquisición de habilidades quirúrgicas básicas en estudiantes de Medicina. Materiales y Método: Estudio cuasiexperimental, antes y después, 124 estudiantes de medicina de cuarto año fueron entrenados con la metodología EPROBA (Entrenamiento Procedimental Básico), previo consentimiento informado. Mediante el instrumento "The Objective StructuredAssessment Of Technical Skills" (OSATS) se evaluó la técnica de sutura previo y posterior a la intervención. Se evaluó la percepción de los estudiantes mediante una encuesta validada. Para el análisis estadístico se utilizó SPSS24® y se usó la prueba Mann Whitney para variables no paramétricas considerando significativo p < 0,05. Resultados: El grupo muestra un progreso promedio significativo en su desempeño procedimental. En la Lista de Comprobación OSATS muestra un progreso desde 4,1 puntos a 8,9 (p < 0,001). En la Escala Global OSATS muestra un puntaje basal de 13,0 puntos, aumentando a 28,0 puntos (p < 0,001). La intervención fue bien percibida, obteniendo un puntaje total promedio de 65,4 puntos de 68 máximos. Conclusión: En nuestra experiencia, un modelo simplificado demostró ser eficaz para el entrenamiento en habilidades procedimentales simples como suturas. Múltiples instancias de práctica deben ser otorgadas por las Facultades de Medicina para la retención y mejora de estas habilidades.

Background: Simulation models provide controlled environments for the practice and tutor feedback. Faced with a first experience, our group implemented a simplified and reproducible model for the training of basic surgical skills. Aim: Communicate the results of a training workshop based on simulation for the basic surgical skills training in medical students. Materials and Method: Quasi-experimental study, before and after, 124 fourth year medical students were trained with "EPROBA" methodology, with prior informed consent. Through the instrument "The Objective Structured Assessment of Technical Skills" (OSATS) the technique of suture before and after the intervention was evaluated. The perception of the students was evaluated through a validated survey. For statistical analysis SPSS24® was used and the Mann Whitney test was used for nonparametric variables, it was considered significant p < 0.05. Results: The group shows a significant average progress in its procedural performance. In the OSATS Checklist they show a progress from 4.1 points to 8.9 after the intervention (p < 0.001). In the OSATS Global Scale they show a baseline score of 13.0 points, rising to 28.0 points (p < 0.001). The intervention was well perceived, obtaining a total average score of 65.4 points of 68 maximums. Conclusión: In our experience, a simplified model proved to be effective for training in simple procedural skills such as sutures. Multiple instances of practice must be granted by the Faculties of Medicine for the retention and improvement of these skills.