RESUMO
BACKGROUND AND OBJECTIVE: Drainage with metallic stents is the treatment of choice in malignant obstructive jaundice. Technical and clinical success with metallic stents is obtained in over 90% and 80% of cases, respectively. There are self-expandable metallic stents designed to increase permeability. The aim of this study was to describe the results obtained with totally covered self-expandable and uncovered self-expandable metallic stents in the palliative treatment of malignant biliary obstruction. PATIENTS AND METHODS: Sixty eight patients with malignant obstructive jaundice secondary to pancreatobiliary or metastatic disease not amenable to surgery were retrospectively included. Two groups were created: group A (covered self-expandable metallic stents) (n = 22) and group B (uncovered self-expandable metallic stents) (n = 46). RESULTS: Serum total bilirubin, direct bilirubin, alkaline phosphatase and gamma glutamyl transferase levels decreased in both groups and no statistically significant difference was detected (p = 0.800, p = 0.190, p = 0.743, p = 0.521). Migration was greater with covered stents but it was not statistically significant either (p = 0.101). Obstruction was greater in the group with uncovered stents but it was not statistically significant either (p = 0.476). CONCLUSION: There are no differences when using covered self-expandable stents or uncovered self-expandable stents in terms of technical and clinical success or complications in the palliative treatment of malignant obstructive jaundice.
Assuntos
Neoplasias dos Ductos Biliares/complicações , Colestase/terapia , Stents Metálicos Autoexpansíveis , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Colestase/etiologia , Drenagem/instrumentação , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Estudos RetrospectivosRESUMO
BACKGROUND: Assessment of technical dexterity is currently the weakest issue in surgical evaluation. It is imperative to develop an objective exam that allows us to correct training deficiencies and abilities and to objectively feedback education programs and hospitals. The purpose of this study was to perform a correlation between theoretical knowledge and surgical skills. METHODS: We performed a national pilot study in in surgeons certifying by the Mexican Board of Surgery in 2010. This was a two-stage study: written exam (stage I) and oral exam (viva voce) to all surgeons approving the written exam (stage II). In stage II we utilized an objective structured assessment of technical skills (OSATS) whose results were correlated with those of the written and oral exams. The assessment involved seven skill stations and a global rating scale to indicate correctly performed or not and a fail/pass exam, respectively. RESULTS: Sixty-two surgeons approved the written exam in two places. We found no statistical difference among skills in open surgery (bowel anastomosis, liver and vascular suture), laparoscopic surgery (grape pilling, cutting a circle and intracorporeal knot tying) and instrument identification. There was a statistically significant difference (p <0.001) when median values were compared between laparoscopic surgery vs. open surgery and the identification of surgical instruments. There was a correlation between theoretical knowledge and surgical skills. CONCLUSION: When applying an OSATS, we found a positive correlation between theoretical knowledge and surgical skills. This assessment proves to to be valid and reliable for the evaluation of surgical dexterity.
Assuntos
Competência Clínica , Cirurgia Geral/normas , Procedimentos Cirúrgicos Operatórios/normas , México , Projetos Piloto , Inquéritos e QuestionáriosRESUMO
PURPOSE: The aims of this study are to characterize the frequency, density, and distribution of aberrant crypt foci (ACF) and its histological features and to determine the frequency of loss of expression of DNA mismatch repair (MMR) proteins of subjects with hereditary nonpolyposic colorectal cancer (HNPCC) and sporadic colon rectal cancer (CRC). METHODS: Patients with HNPCC, first-degree relatives of subjects with HNPCC, sporadic CRC, and average risk subjects of sporadic CRC were included prospectively. Total colonoscopy with chromoendoscopy using methylene blue 0.5% and magnification in the right colon (cecum and 20 cm of the ascending colon) and in the left colon (rectum) was performed; loss of expression of MLH1 and MSH2 was evaluated by immunohistochemistry in confirmed ACF. RESULTS: Fifty-two subjects were included. Thirty-eight of the 119 ACF detected by endoscopy were biopsied. In 14 of the 38 specimens (36.8%), ACF were confirmed by histology (Cohen's kappa, 0.44). In subjects with HNPCC, ACF were identified more frequently in the right segment of the colon than in the left (73.1% vs. 26%); in contrast, ACF predominated in the left segment of the colon (89.3% vs. 10.6%) in subjects with sporadic CRC. There was a loss of MLH1 expression in ACF in subjects with HNPCC. CONCLUSIONS: In HNPCC, we found a greater density of ACF in the right colon, and in sporadic CRC, greater density in the left. ACF present loss in the expression of DNA MMR protein and can be used as an early marker in patients with a risk of HNPCC in whom carcinogenesis appears to be accelerated.