A 53-year-old male patient underwent a Nissen fundoplication with short gastric vessel (SGV) division for gastroesophageal reflux disease. During the procedure, the upper pole of the spleen was noted to have discrete color changes suggesting ischemia of this area. One month later he presented with a splenic abscess, which required splenectomy. The clinical presentation and management of this case is reported and comments are made on surgical aspects of SGV division during fundoplication to prevent this potentially dangerous situation. Issues such as the surgical management of splenic abscesses, the limitations of laparoscopic splenectomy in these cases, and the risks and benefits of SGV division, are also discussed in this article.
Morgagni's hernias represent between 2 and 4% of the whole of nontraumatic diaphragmatic hernias in the adult, and the treatment (even with minimal symptoms) is always with surgery. We present the case of a 50-year-old woman with an oppressive, postprandial discomfort in the right side of her thorax and with increased pain when supine. The x-ray examination indicated a large portion of transverse colon inside the thoracic cavity. Once the diagnosis of Morgagni's hernia had been obtained, she was scheduled for laparoscopic surgery to reduce the hernia and to reconstruct the defect of the diaphragm using a polypropylene mesh.
Introducción: Formar en valores éticos a los futuros médicos, es esencial para las escuelas de medicina, por ello es importante conocer sus preferencias en valores. Objetivo: Investigar la preferencia y jerarquía de valores, en alumnos de medicina y contrastarla con estudios similares. Método: Estudio descriptivo, transversal, cuantitativo y cualitativo en estudiantes de medicina de la Universidad Anáhuac México, mediante un instrumento validado. Resultados: De 692 cuestionarios, 567 fueron útiles para el análisis, 407 mujeres (58.8%) y 285 hombres (41.2%), con edad promedio de 20.8 años. La distribución por semestre fue: primero 19.4%, segundo 16.5%, tercero 10.7%, cuarto 19%, quinto 11.7%, sexto 11.1%, séptimo 9% y octavo 8.8%. De los valores propuestos, respeto ocupó el primer lugar (66.5%) y en orden descendente honestidad (65.8%), familia (63.85%) y responsabilidad (52.9%). La vida fue escogida por 27.3% y dignidad por 39.5% de los alumnos. A excepción del valor religión, la prueba ANOVA no proporcionó evidencia de cambios significativos entre más avanzada fuera su formación académica. La prueba de Chi cuadrada de Pearson entre estudiantes de primero y octavo semestre contrastando cada valor, no reveló diferencias significativas en la mayoría de los valores encuestados, lo que sugiere que la formación recibida no hizo diferencia entre los valores elegidos entre el primero y octavo semestre, aunque alumnos en su mayoría aprecian la importancia de la formación recibida en valores. Conclusiones: Formar en valores es imprescindible para los futuros médicos, es importante investigar las preferencias axiológicas de los estudiantes para orientarlos y planear estrategias para que los profesionales actúen éticamente respetando la dignidad de los pacientes.
RESUMENObjetivo: Describir los resultados de 327 reparaciones via laparoscópica de hernias inguinales. Material y métodos: Estudio descriptivo de 327 reparaciones vía laparoscópica de hernias inguinales practicadas en 257 pacientes, realizadas entre 1992 y 1996 en el Servicio de Cirugia del American British Cowdray Medical Center, en México Distrito Federal. Resultados: El sexo fue predominantemente masculino (77.4 %); las edades oscilaron entre 9 y 89 años. En 85 pacientes se trató de hernia inguinal bilateral y de ellas se trataron en 35 casos según la técnica de Stoppa. Tres de los casos se desarrollaron como cirugía de urgencia por el compromiso intestinal concomitante. Las complicaciones representaron el 8.8 % y se resolvieron espontáneamente; constituidas por meralgia parestésica, retención urinaria, hematomas inguino escrotales. Las recidivas constituyeron el 1.2 %. Conclusiones: Los autores establecen el manejo de las hernias bajo una propuesta de clasificación laparoscópica de los defectos herniarios basada en la de Nyhus. ( Rev Med Hered 1999; 10: ).
La refl exión sobre las actitudes y motivos que mueven a los cirujanos son indispensables para la adecuada estrategia decisional. La búsqueda basada en la razón, los valores y la metodología que nos brinda la ética y bioética pueden ayudar a encontrar las respuestas adecuadas para decidir optando por el bien y lo correcto. Las nociones del marco antropológico adecuado, el bien, la fi nalidad y tener clara la jerarquía de valores ayudan al análisis.
The use of implanted medical devices such as gastric pacers to treat a great variety of diseases, has gained ground over time. Even though these devices are useful as in cases of gastroparesis, gastroesophageal reflux or morbid obesity, they have risks and complications that can be life threatening. Extrinsic intestinal obstruction may be caused by the lead of an abdominally implanted pacemaker, and should be considered in patients with suggestive signs and symptoms of bowel obstruction and treated promptly to avoid further damage. We present the case of a 76-year-old patient with bowel obstruction caused by the lead of a gastric pacemaker solved by laparoscopic surgery
Introducción: La diferenciación, en la interpretación radiológica, entre la neumobilia y el gas portal tiene implicaciones clínicas y terapéuticas de gran importancia. El presente trabajo tiene por objetivo describir los criterios radiológicos y clínicos más relevantes de estas dos entidades, con el fin de disminuir la confusión que puede existir entre ellas. Caso clínico: Paciente masculino de 40 años con cuadro gastroenteral en cuya radiografía simple de abdomen se malinterpretan unas zonas radiolúcidas del parénquima hepático como neumobilia y se provoca un aumento innecesario de estudios y comorbilidades. Conclusión: Diferenciar entre neumobilia y gas portal es un reto que exige la cooperación estrecha entre radiólogos y clínicos. Ambas circunstancias pueden estar relacionadas con patologías de un amplio espectro de severidades y, por lo tanto, la integración de un diagnóstico debe ser cuidadosamente complementado entre la clínica y los resultados de imagen.
To contribute to the construction of young professionals with an integral profile in which the competitive spirit is promoted through the resolution of a technological challenge applied to the Oil & Gas industry, under a scenario that demands a high degree of commitment and with the accompaniment of professionals with great experience in the industry. In accordance with the data acquired and the program's target population, an appropriate methodology has been established for the development and strengthening of technical and soft skills. This methodology consists of four main phases: 1. Challenge construction 2. Best Teams selection 3. Challenge Resolution and 4. Results presentation. During the challenge resolution phase, participants have multiple technical and soft skills training sessions where experienced professionals share their knowledge and experiences related to the challenge theme in an environment of generational knowledge transfer. During the last 4 years, around 120 participants from different cities of the country have managed to potentiate their soft skills and strengthen their knowledge in areas of the Oil & Gas industry such as unconventional, enhanced recovery, heavy oil, huff & puff, combustion had tests, wettability, waterflooding, among others and materialize it with the construction of an innovative technological tool. The best of each version was rewarded with their first work experience in the Oil & Gas industry where they were able to put into practice what they had learned during the program. Likewise, the continuous acquisition of valuable information about variables at the end of the program such as the knowledge areas of greatest interest for students and young professionals, the level of knowledge related to oil engineering and programming, the handling of a second language, and the skills acquired during the university training stage, has allowed strengthening the methodology of the"SPE en Sinergia" program, adjusting it to the current needs of the industry and placing the participants outside their comfort zone. The development of the program and the results obtained are based on the identification of the strengths and weaknesses currently displayed by students in their final semesters and young professionals in careers related to petroleum engineering in Colombia and that in one way or another have become part of the reasons why their link to the professional world has become more difficult. This has enabled a way to identify opportunities for improvement and establish lines of action to promote the professional fast-track development of the new generations in a joint effort between industry and academia.
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