Laparoscopic training model using fresh human cadavers without the establishment of penumoperitoneum.

BACKGROUND: Laparoscopy is a well-established alternative to open surgery for treating many diseases. Although laparoscopy has many advantages, it is also associated with disadvantages, such as slow learning curves and prolonged operation time. Fresh frozen cadavers may be an interesting resource for laparoscopic training, and many institutions have access to cadavers. One of the main obstacles for the use of cadavers as a training model is the difficulty in introducing a sufficient pneumoperitoneum to distend the abdominal wall and provide a proper working space. The purpose of this study was to describe a fresh human cadaver model for laparoscopic training without requiring a pneumoperitoneum. MATERIALS AND METHODS AND RESULTS: A fake abdominal wall device was developed to allow for laparoscopic training without requiring a pneumoperitoneum in cadavers. The device consists of a table-mounted retractor, two rail clamps, two independent frame arms, two adjustable handle and rotating features, and two frames of the abdominal wall. A handycam is fixed over a frame arm, positioned and connected through a USB connection to a television and dissector; scissors and other laparoscopic materials are positioned inside trocars. The laparoscopic procedure is thus simulated. CONCLUSION: Cadavers offer a very promising and useful model for laparoscopic training. We developed a fake abdominal wall device that solves the limitation of space when performing surgery on cadavers and removes the need to acquire more costly laparoscopic equipment. This model is easily accessible at institutions in developing countries, making it one of the most promising tools for teaching laparoscopy.

Prospective Randomized Trial Comparing Hepatic Venous Outflow and Renal Function after Conventional versus Piggyback Liver Transplantation.

BACKGROUND: This randomized prospective clinical trial compared the hepatic venous outflow drainage and renal function after conventional with venovenous bypass (n = 15) or piggyback (n = 17) liver transplantation. METHODS: Free hepatic vein pressure (FHVP) and central venous pressure (CVP) measurements were performed after graft reperfusion. Postoperative serum creatinine (Cr) was measured daily on the first week and on the 14th, 21st and 28th postoperative days (PO). The prevalence of acute renal failure (ARF) up to the 28th PO was analyzed by RIFLE-AKIN criteria. A Generalized Estimating Equation (GEE) approach was used for comparison of longitudinal measurements of renal function. RESULTS: FHVP-CVP gradient > 3 mm Hg was observed in 26.7% (4/15) of the patients in the conventional group and in 17.6% (3/17) in the piggyback group (p = 0.68). Median FHVP-CVP gradient was 2 mm Hg (0-8 mmHg) vs. 3 mm Hg (0-7 mm Hg) in conventional and piggyback groups, respectively (p = 0.73). There is no statistically significant difference between the conventional (1/15) and the piggyback (2/17) groups regarding massive ascites development (p = 1.00). GEE estimated marginal mean for Cr was significantly higher in conventional than in piggyback group (2.14 ± 0.26 vs. 1.47 ± 0.15 mg/dL; p = 0.02). The conventional method presented a higher prevalence of severe ARF during the first 28 PO days (OR = 3.207; 95% CI, 1.010 to 10.179; p = 0.048). CONCLUSION: Patients submitted to liver transplantation using conventional or piggyback methods present similar results regarding venous outflow drainage of the graft. Conventional with venovenous bypass technique significantly increases the harm of postoperative renal dysfunction. TRIAL REGISTRATION: ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT01707810.

Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP): descrição de um projeto musical de gestão, comunicação e relacionamento dos acadêmicos de medicina da Faculdade de Medicina da Universidade de São Paulo / “Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP)”: description of a project of music, management, communication and relationship of medical students of“Faculdade de Medicina da Universidade de São Paulo”

Recentemente tem se discutido muito sobre a formação médica dos acadêmicos das faculdades de medicina. A humanização é um aspecto que influencia a formação de um profissional médico com aptidão para lidar com seres humanos. Estudantes daFaculdade de Medicina da Universidade de São Paulo (FMUSP) com interesse em música se reuniram e formaram um grupo que realiza apresentações musicais em um recital. Assim foi criadoo Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP). Os membros do REMUSP realizam ensaios no Teatro da Faculdade de Medicina da USP de quatro a cinco horas por semana, aproximadamente, organizados através de grupos de Facebook e e-mail. No ano de 2011, durante a sua primeira apresentação, os membros do REMUSP executaram peças predominantemente do estilo clássico e popular, como: Canon In D – Johann Pachelbel, Ave Maria – Johann Sebastian Bach, Solfeggietto – C.P.E. Bach, Can You Feel The Love Tonight? – Elton John, New York, New York – Frank Sinatra, Kiss From a Rose – Seal etc. Atualmente, o REMUSP procuraestimular a cooperatividade e organização nas apresentações musicais, sendo que os ensaios são cada vez mais preenchidos por peças tocadas em conjuntos, em detrimento das individuais, visando à integração e ao aperfeiçoamento da comunicação eorganização de um grupo musical composto por futuros médicos mais humanizados...

Recently there has been an important discussion about the training of medical students from medical colleges.Humanization is an aspect that influences the formation of a medical professional with the ability to deal with human beings. Students of the Faculty of Medicine, University of SãoPaulo (USP) interested in music came together and formed a group that performs in a musical recital. Thus was created the Recital Students of Medicine, University of São Paulo(REMUSP). Members of REMUSP perform musical rehearsals at the Theatre, Faculty of Medicine, USP, four to five hours per week, approximately, organized through Facebook groupsand e-mail. In 2011, during their first presentation, members of the REMUSP performed predominantly classic style and popular as: Canon In D - Johann Pachelbel, Ave Maria - JohannSebastian Bach, Solfeggietto - CPE Bach, Can You Feel The Love Tonight? - Elton John, New York, New York - FrankSinatra, Kiss From a Rose - Seal etc. Currently, the demand REMUSP stimulate cooperatively and organization in musical performances, and musical rehearsals are increasingly filled by pieces to be played by a group, at the expense of the individual,aiming at integration and improvement of communication and organization of a musical group composed of future doctors more humanized...