RESUMO
Introducción. El manejo perioperatorio de las urgencias hepatobiliares por parte del cirujano general es una competencia esperada y se considera un reto por su relativa frecuencia, impacto en la salud del individuo y la economía, así como las implicaciones en el ejercicio clínico confiable y de alta calidad. Se desconocen los aspectos formales de la educación en cirugía hepatobiliar para el cirujano general en Colombia. El objetivo del presente estudio fue explorar la perspectiva de los cirujanos hepatobiliares sobre esta problemática. Métodos. Se realizó un estudio cualitativo, mediante entrevistas semiestructuradas con 14 especialistas en cirugía hepatobiliar colombianos, en donde se exploraron los desafíos del entrenamiento, el tiempo y las características de una rotación, la evaluación de la confiabilidad, el número de procedimientos y el rol de la simulación. Se hizo un análisis temático de la información. Resultados. Los expertos mencionaron la importancia de la rotación obligatoria por cirugía hepatobiliar para los cirujanos en formación. El tiempo ideal es de tres meses, en el último año de residencia, en centros especializados, con exposición activa y bajo supervisión. Conclusiones. Por las características epidemiológicas del país y la frecuencia de enfermedades hepatobiliares que requieren tratamiento quirúrgico, es necesario que el cirujano general cuente con una formación sólida en este campo durante la residencia. El presente estudio informa sobre las características ideales del entrenamiento en este campo desde la visión de los expertos colombianos.
Introduction. The perioperative management of hepatobiliary emergencies by the general surgeon is an expected competence and is considered a challenge due to its relative frequency, impact on the individual health and the economy, as well as the implications for reliable and high-quality clinical practice. The formal aspects of education in hepatobiliary surgery for the general surgeon in Colombia are unknown. The objective of the present study was to explore the perspective of hepatobiliary surgeons on this problem. Methods. A qualitative study was carried out through semi-structured interviews with 14 Colombian hepatobiliary surgery specialists, where the challenges of training, time and characteristics of the rotation, evaluation of reliability, number of procedures and role of simulation. A thematic analysis of the information was carried out. Results. The experts mentioned the importance of mandatory rotation for hepatobiliary surgery for surgeons in training. The ideal duration was three months, during the last year of residency, in specialized centers with active exposure and under supervision. Conclusions. Due to the epidemiological characteristics of the country and the frequency of hepatobiliary diseases that require surgical treatment, it is necessary for the general surgeon to have solid training in this field during residency. The present study reports on the ideal characteristics of training in this field from the perspective of Colombian experts.
Assuntos
Humanos , Procedimentos Cirúrgicos do Sistema Biliar , Educação de Pós-Graduação em Medicina , Cirurgia Geral , Doenças Biliares , Tratamento de Emergência , Treinamento por SimulaçãoRESUMO
BACKGROUND: Colonial invertebrates such as corals exhibit nested levels of modularity, imposing a challenge to the depiction of their morphological evolution. Comparisons among diverse Caribbean gorgonian corals suggest decoupling of evolution at the polyp vs. branch/internode levels. Thus, evolutionary change in polyp form or size (the colonial module sensu stricto) does not imply a change in colony form (constructed of modular branches and other emergent features). This study examined the patterns of morphological integration at the intraspecific level. Pseudopterogorgia bipinnata (Verrill) (Octocorallia: Gorgoniidae) is a Caribbean shallow water gorgonian that can colonize most reef habitats (shallow/exposed vs. deep/protected; 1-45 m) and shows great morphological variation. RESULTS: To characterize the genotype/environment relationship and phenotypic plasticity in P. bipinnata, two microsatellite loci, mitochondrial (MSH1) and nuclear (ITS) DNA sequences, and (ITS2) DGGE banding patterns were initially compared among the populations present in the coral reefs of Belize (Carrie Bow Cay), Panama (Bocas del Toro), Colombia (Cartagena) and the Bahamas (San Salvador). Despite the large and discrete differentiation of morphotypes, there was no concordant genetic variation (DGGE banding patterns) in the ITS2 genotypes from Belize, Panama and Colombia. ITS1-5.8S-ITS2 phylogenetic analysis afforded evidence for considering the species P. kallos (Bielschowsky) as the shallow-most morphotype of P. bipinnata from exposed environments. The population from Carrie Bow Cay, Belize (1-45 m) was examined to determine the phenotypic integration of modular features such as branch thickness, polyp aperture, inter-polyp distance, internode length and branch length. Third-order partial correlation coefficients suggested significant integration between polypar and colonial traits. Some features did not change at all despite 10-fold differences in other integrated features. More importantly, some colonial features showed dependence on modular features. CONCLUSION: Consequently, module integration in gorgonian corals can be shifted, switched or canalized along lineages. Modular marine organisms such as corals are variations on a single theme: their modules can couple or decouple, allowing them to adapt to all marine benthic environments.
Assuntos
Antozoários/anatomia & histologia , Antozoários/fisiologia , Evolução Biológica , Ecossistema , Animais , Antozoários/genética , Marcadores Genéticos/genética , Genótipo , Biologia Marinha , Oceanos e Mares , FenótipoRESUMO
Gorgoniid octocorals taxonomy (Cnidaria; Octocorallia; Gorgoniidae) includes diagnostic characters not well defined at the generic level, and based on the family diagnosis some species could be classified in either Gorgoniidae or Plexauridae. In this study, we used sequences from the Internal Transcribed Spacer 2 (ITS2) and their predicted RNA secondary structure to both correct the alignment and reconstruct phylogenies using molecular morphometrics for 24 octocorals mostly from the Atlantic. ITS2 exhibited the six-helicoidal ring-model structure found in eukaryotes, and provided 38 parsimony-informative characters. The proposed phylogenies, though differing between sequence- and structure-base results, provided consistent support for several clades. Genera considered part of the polyphyletic genus Leptogorgia, such as Filigorgia, were distantly related to the former in all phylogenetic hypotheses. Main differences among the hypotheses consisted in the placement of Muriceopsis (previously considered from the Plexauridae family) and Filigorgia. Excluding Muriceopsis and an undescribed octocoral from Tobago, Plexaurella and Pterogorgia grouped together as a sister branch of Pinnigorgia spp. but long-branch attraction was evident for the grouping of Plexaurella nutans (another plexaurid) and Pterogorgia citrina. Unexpected results were the divergence between Caribbean genera, Gorgonia and Pseudopterogorgia, which were placed basal respect to Pacifigorgia and Leptogorgia (=Lophogorgia). ITS2 provided support to corroborate observations based on sclerite morphology: species with "capstan sclerites" (e.g., Pacifigorgia and Leptogorgia) were characterized by a long helix IV with one internal loop and a helix V with four internal loops; "scaphoid sclerites" had a predominantly long helix V if compared to helix IV; "asymmetric spiny sclerites" (Muriceopsis, Pinnigorgia and the undescribed octocoral) exhibited one or two lateral bulges in the V helix. Remarkably, Muriceopsis and Pinnigorgia were supported by a complete Compensatory Base Change (CBC) (A-U to G-C) in helix V. Filigorgia with simple "spindles" had a short helix IV and a large central ring. DNA sequences from the nuclear ITS2 region, including information from predicted RNA secondary structure, despite their reduced length, provided numerous characters and phylogenetic information among Gorgoniidae genera and species.
Assuntos
Cnidários/genética , DNA Espaçador Ribossômico/genética , Filogenia , Animais , Cnidários/classificação , Modelos Genéticos , Dados de Sequência Molecular , Conformação de Ácido Nucleico , RNA Ribossômico/química , RNA Ribossômico/genética , Análise de Sequência de DNARESUMO
BACKGROUND: Silicone has been the standard material for indwelling devices to date. Polyurethane II exhibits properties that makes it suitable as a component of long-indwelling vascular access, with the added advantage of low cost. OBJECTIVE: To describe the experience of an intravenous therapy team with 206 polyurethane II catheters used as long-indwelling vascular access in patients with cancer. MATERIALS AND METHODS: All polyurethane II single- and double-lumen catheters implanted between January 1, 1994, and March 15, 1995, were analyzed, including time of stay and type and rate of infectious and noninfectious complications. RESULTS: A total of 206 catheters were placed--164 single-lumen and 42 double-lumen catheters--in 190 patients; average stay was 101 days (range, 1-445 days). The infection incidence rate was 0.66 per 1000 catheter-days for single-lumen catheters and 1.6 per 1000 catheter-days for double-lumen catheters. Noninfectious complications included 1 thrombosis (incidence rate, 0.06 per 1000 catheter-days for single-lumen and none for double-lumen catheters), 5 catheter ruptures (2.4%), and 1 pneumothorax (0.48%). Twelve catheters (8.3%) were removed because of complications; only 1 was infectious. The remaining 17 infectious episodes (94.4%) were resolved without catheter removal. Our complication rate with single-lumen catheters in this series was similar to our previous experience with a nontunneled silicone catheter. CONCLUSIONS: Our findings indicate that polyurethane II catheters have proven useful and safe as long-indwelling vascular access in patients with cancer at our hospital at a considerably lower cost.
Assuntos
Infecções Bacterianas/epidemiologia , Cateterismo/efeitos adversos , Cateteres de Demora/microbiologia , Infecção Hospitalar/epidemiologia , Poliuretanos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Cateterismo/instrumentação , Cateteres de Demora/efeitos adversos , Cateteres de Demora/economia , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Incidência , Controle de Infecções , Tempo de Internação , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológicoRESUMO
Se presenta la experiencia con el uso infusores para quimioterapia ambulatoria vigilado por un Equipo de Terapia Intravenosa en el Instituto Nacional de Cancerología. Se incluyeron todos los pacientes que recibieron quimioterapia ambulatoria por medio de infusores a través de un catéter para permanencia prolongada de abril de 1989 a diciembre de 1991. Se registraron los días/infusores, ciclos de quimioterapia, días de neutropenia, complicaciones infecciosas y no infecciosas relacionadas al uso de infusores así como del catéter de permanencia prolongada. En los casos con infección, se recabaron los microorganismos aislados. Se estudiaron 32 pacientes con edad promedio 53 años. Se administraron 106 ciclos de quimioterapia con 418 infusores. No se identificó ninguna complicación infecciosa relacionada al uso de infusores; únicamente se registraron dos episodios de infección del sitio de inserción del catéter, uno de ellos con bacteremia secundaria. Solo en un caso hubo falla mecánica de infusor. No hubo mortalidad asociada ni al uso de infusores ni al catéter para permanencia prolongada. La quimioterapia a través del uso de infusores es una opción real en nuestro medio, siempre y cuando los pacientes se apeguen estrictamente a las normas establecidas por el Equipo de Terapia Intravenosa