immediate perineal reconstruction after vast rectal abdominoperineal resection background: Buschke-Lowenstein tumor is a benign skin lesion secondary to human papilloma virus infection. It usually appears as an exophytic anogenital mass and may progress to a squamous cell carcinoma. It can be treated with chemo, radio or immunotherapy and occasionally it requires radical surgery. case report: We report a 53 years old male with a perianal lesion lasting 15 years that was treated with chemoradiotherapy that relapsed with malignant transformation. Since the pathological study showed a squamous cell carcinoma, a rectal abdominoperineal resection was planned. The defect that left the surgical procedure was covered with musculocutaneous flaps from gracilis muscle of the thigh.
La apendicitis y su historiaAppendicitis and its history Sr. Editor: Con gran interés hemos leído el excelente artículo "La apendicitis y su historia", escrito por el Dr. Pablo Young 1 . La reseña, muy bien documentada, ofrece un ameno recorrido por la historia de la apendicitis aguda, patología rica en elementos semiológicos, personajes y anécdotas. En un afán constructivo, quisiéramos complementar el relato del Dr. Young refiriéndonos a un hito que también forma parte de la historia de esta patología: la primera auto-apendicectomía realizada en condiciones extremas.El hecho ocurrió en 1961 y su protagonista fue Leonid Rogozov , cirujano de 27 años oriundo de Leningrado e integrante de la VI Expedición Antártica Soviética, comisionada para establecer en dicho territorio la base Novolaza revskaya. Médico único en territorio hostil, el día 29 de abril Rogozov presentó los síntomas característicos de la enfermedad, diagnosticándose un cuadro altamente probable de apendicitis aguda. Inició tratamiento conservador (antibióticos, frío local). Sin embargo, su condición empeoró progresivamente. Rogozov, sin posibilidad de recibir ayuda externa, tomó la decisión de realizar una auto-apendicectomía. Para tales efectos, instruyó a sus compañeros de expedición para improvisar un pabellón y esterilizar el material quirúrgico ad hoc. Tres de ellos cumplieron roles claves: el meteorólogo Alexandr Artemev (quien desempeñó el rol de arsenalero), el mecánico Zinovy Teplinsky (encargado de sujetar un espejo y ajustar la luz) y el director de la base Vladislav Gerbovich (quien quedó "de reserva", en caso que las náuseas impidieran a los dos anteriores desempeñar sus funciones). En la madrugada del 1 de mayo Rogozov comenzó el procedimiento quirúrgico, a mano desnuda, con el fin de preservar su sentido del tacto para guiarse. Utilizó anestesia local con procaína y procedió a realizar una incisión de 10 a 12 cm. La auto-apendicectomía duró 1 hora y 45 minutos, durante los cuales Rogozov tuvo que tomar pequeños descansos, producto de su debilidad
surgical procedures performed by general surgery residents introduction:The national Society of Surgery has defined the minimum number of surgical procedures that must be performed by general surgeons in trainee, however, there is no national data reporting this accomplishment. The aim of this study is to report on detail the surgical interventions performed by General Surgery Residents at the Pontificia Universidad Catolica de Chile (PUC) as lead surgeons. methods: Retrospective analysis of surgical procedures performed by 26 Residents of the General Surgery Program (GSP) at PUC who graduated between the years 2012 and 2014. A total of 10.102 registered surgeries were reviewed and summarized. results: The mean number of interventions performed by surgery residents was 481 (20% of them on the first year). The most frequently performed procedures were (mean per resident) laparoscopic cholecystectomy (115;24%), open appendectomy (89;19%), classic hernioplasty (43;9%), laparoscopic appendectomy (34;7%) and open cholecystectomy (25;5%). Regarding complex/sub-specialty interventions, partial/ total colectomy (12;2%), thyroidectomy-parathyroidectomy (9;2%), vascular access (8;2%), thoracotomy-VATS-sternotomy (5;1%) and breast surgery (4;1%) were the most commonly performed. Fifty three percent of all procedures were done in an emergency setting. The proportion of emergency procedures increased through the GSP training (elective vs emergency: 62 vs 38% at first year and 34 vs 66% at third year, respectively; p < 0.002). Interventions were mainly performed in the capital city of Chile, Santiago (74%) and the remaining were done in other provinces. Regarding only abdominal interventions (mean per resident: 366), 42% was performed by laparoscopy. conclusions: Residents of the PUC-GSP execute a considerable large amount of interventions as resident surgeons throughout their 3-years-training program, exceeding the minimum recommendations established by the national Society of Surgery.
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