RESUMO
BACKGROUND: Marjolin's ulcer is defined as the appearance of a neoplasm within a chronic wound. The most common histological type is squamous. A total of 2 cases treated in our hospital are presented. CLINICAL CASE: Case 1. A 71 year old man who presented with redness and suppuration from the wounds he had in his right foot after an electric shock 40 years earlier. The radiology showed involvement of the 4° and 5° metatarsal. Supracondylar amputation was performed, showing a well-differentiated invasive squamous cell carcinoma. CASE 2: A 56 year old male, paraplegic for 20 years. He was treated due to an infected right heel ulcer, with partial improvement, but the ulcers persisted. Biopsy was performed, reporting as epidermoid carcinoma. Infracondylar amputation was performed. The diagnosis was a well-differentiated squamous cell carcinoma infiltrating the dermis. CONCLUSION: The prevalence of Marjolin's ulcer is 1.3-2.2% of all ulcers. Diagnosis is difficult, so biopsy is recommended on any suspicious lesion or ulcer that has received conservative treatment for one month without improvement, although this time limit is not clear. The treatment is the surgery. Local excision with a margin of an inch is enough. If the ulcer is extensive, amputation is required. Survival is estimated between 66 and 80% at 2 years, with recurrence rates of 23%. Unfavourable factors are poor tumour differentiation and metástasis, appearing in 20% of cases.
Assuntos
Queimaduras por Corrente Elétrica/complicações , Carcinoma de Células Escamosas/etiologia , Traumatismos do Pé/complicações , Úlcera do Pé/etiologia , Neoplasias Cutâneas/etiologia , Idoso , Amputação Cirúrgica , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/cirurgia , Pé Diabético , Úlcera do Pé/epidemiologia , Úlcera do Pé/cirurgia , Unidades Hospitalares , Humanos , Masculino , México/epidemiologia , Paraplegia/complicações , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgiaRESUMO
BACKGROUND: Today laparoscopic approach is essential, but learning is usually expensive and very limited. Homemade and low equipment costs are required. We undertook this study to quantify how many hours of training are necessary for a surgeon without laparoscopic experience in order to acquire the abilities to carry out procedures as a staff member with laparoscopic experience. METHODS: A low-cost laparoscopic trainer was constructed. Four exercises of increasing difficulty have been developed. Five residents without laparoscopic experience and four experts developed the study. A satisfaction questionnaire was completed. Data were analyzed comparing the average times for the accomplishment of each exercise between groups. RESULTS: Data showed that the more difficult an exercise is, the more training is required. The average time needed to acquire similar skills as experts was almost 7 h of training spread over 4 months. The level of confidence for approaching a laparoscopic procedure for residents after completing the training was increased by 70%. CONCLUSION: Laparoscopic training is essential in the formation of all surgeons and a reason why this low-cost and easily accessible method could become a basic tool for learning the first steps of the laparoscopic procedure.
Assuntos
Competência Clínica , Internato e Residência , Laparoscopia/economia , Laparoscopia/educação , Adulto , Custos e Análise de Custo , Feminino , Humanos , Curva de Aprendizado , Masculino , Estudos Prospectivos , Fatores de TempoRESUMO
Burnout syndrome may affect >50% of physicians and is characterized by feelings of emptiness and negative attitudes towards work and life. The work of surgeons presented some specific causal factors that determine that the physician (as a professional) can "burn out" and suffer from this disease with the consequent social/laborial impact, affecting also the rest of the surgical service. These may include external factors linked to the health organization or to internal factors that are directly dependent on the type of work performed by the hospital surgeon. This study analyzes these causal factors of burnout and offers some simple coping strategies in order to improve the health of professionals.
Assuntos
Esgotamento Profissional/prevenção & controle , Cirurgia Geral , Doenças Profissionais/prevenção & controle , Esgotamento Profissional/etiologia , Humanos , Doenças Profissionais/etiologiaRESUMO
El síndrome de burnout puede afectar a más de 50 % de los médicos y se caracteriza por sentimiento de vacío y actitudes negativas hacia el trabajo y la vida. La actividad laboral de los cirujanos presenta factores causales específicos que determinan que el profesional pueda padecer esta enfermedad, con la consiguiente repercusión sociolaboral y para el resto del servicio. Estos factores pueden ser externos, ligados a la organización sanitaria, o internos, que dependen de la actividad laboral del cirujano en el hospital. En este trabajo se analizan dichos factores causales de burnout y se proponen algunas estrategias de afrontamiento para mejorar la salud de los profesionales.
Burnout syndrome may affect >50% of physicians and is characterized by feelings of emptiness and negative attitudes towards work and life. The work of surgeons presented some specific causal factors that determine that the physician (as a professional) can "burn out" and suffer from this disease with the consequent social/laborial impact, affecting also the rest of the surgical service. These may include external factors linked to the health organization or to internal factors that are directly dependent on the type of work performed by the hospital surgeon. This study analyzes these causal factors of burnout and offers some simple coping strategies in order to improve the health of professionals.