Continuing medical education (CME) as a permanent tool for learning CME is a challenge that our Universities have to assume not only after they give the final degree, although this must be done since students' begin their studies, due the changing scenarios that they are exposed. The increasing number of students that have now access to university studies, with important deficiencies in their formal education, but with high expectative, challenge universities to innovate in curriculums based competences, using expensive technological resources in order to give answers to the increasing demands, according to the expectative given by Chile in their international commitments. Is in this context that universities becomes the principal provider of qualified human resources that is demanded by our society for his development in a globalised world, where professionals, not only in health area, must be able to use this competences for a satisfactory performance. For a high quality CME, is of relevance that universities with their Medical Education Offices, must work together with Scientific Societies and with the different institution that works in health. For this purpose is of great importance that these institutions must know, not only the new scenarios where workers are involved, but they are in front of professionals with highly self instructions aptitudes, low time to spent in education but with multiple sources of information that challenge educators to be highly qualified, with newly concepts to assess their educational process and be in a permanent improvement of their own necessities to improve their own competences.Key words: Continuing medical education, universities, graduate. ResumenLa Educación Médica Continua (EMC) es un desafío que deben asumir las universidades no sólo después de recibido el título universitario, sino desde el momento mismo que ingresan los estudiantes a sus aulas dado los escenarios cambiantes a los que ésta se ve enfrentada. El aumento explosivo del número de estudiantes que ingresan en la actualidad, con importantes carencias de formación pero con un alto grado de exigencias; las obliga a innovar no sólo en modificar sus currículos en base a competencias, incorporando costosos recursos informáticos; sino que responder a las altas exigencias a las que, además, se ven enfrenRev.
Evolution and prognosis of differentiated thyroid carcinomaBackground: Differentiated thyroid carcinoma has a good prognosis with a 90% survival at 10 years. Follicular carcinoma is more aggressive than papillary carcinoma Aim: To study the clinical presentation, evolution and prognosis of differentiated thyroid carcinoma. Material and Methods: The pathological registries of differentiated thyroid cancer processed in a pathology service of a general hospital, between 1984 and 2007, were searched. The clinical records of patients were reviewed. Results: One hundred six pathology registries were identified but only 89 patients had complete medical records. Seventy six patients aged 44 ± 16 years had a papillary carcinoma and 13 patients aged 42 ± 15 years had a follicular carcinoma. After a mean follow up of 53 months, 65 patients with papillary and 12 patients with follicular thyroid cancer were alive. Five patients with papillary carcinoma and one with follicular carcinoma had a local or distant relapse. Calculated actuarial survival at 10 years was 84 and 100% for papillary and follicular carcinoma, respectively. Ten year survival for stage I, II, III and IV tumors was 100, 92, 68 and 0%, respectively. Mortality was associated with the presence of distant metastases, a stage IV tumor, vascular or lymphatic tumor infiltration, tumor size, lymph node involvement, extra capsular invasion and a multi focal lesions. The relative risk for mortality increases between 2.7 and 9 times with the presence of lymph node infiltration and distant metastases. Conclusions: The prognosis of differentiated thyroid cancer is related to lymph node infiltration and the presence of distant metastases.
RESUMENIntroducción: La obesidad mórbida es una patología de creciente consulta en nuestro medio a la cual los servicios de salud público no están ajenos. En la actualidad la cirugía ha demostrado ser el tratamiento más eficaz a largo plazo. Objetivos: Informar los resultados obtenidos en el tratamiento de obesos mórbidos sometidos a cirugía abierta en un servicio hospitalario público regional. Material y método: Se analiza en forma prospectiva los primeros 100 pacientes sometidos a cirugía bariátrica en el Hospital de Coquimbo entre Septiembre de 1998 y Diciembre de 2005. Se usaron 3 técnicas en forma consecutiva. En todas ellas se efectuó el bypass gástrico empleando anastomosis en Y de Roux con asa larga de 160 cm. Para los análisis estadísticos se emplearon los test de ANOVA y Student. Resultados: El 83% de los operados fueron mujeres. El IMC preoperatorio promedio fue de 46 kg/m 2 , siendo un 29% superobesos (IMC>50). La estadía postoperatoria promedio fue de 7,6 días. Complicaciones postoperatorias precoces hubo en el 5%. No se registró mortalidad operatoria en esta serie. El promedio de reducción de exceso de peso fue de 60% a los 6 meses, 72% al año y 66% a los 3 años. Conclusiones: Los resultados obtenidos en un hospital público regional en relación a la cirugía bariátrica son absolutamente comparables a estudios nacionales e internacionales, tanto en la reducción de peso como en la morbimortalidad.PALABRAS CLAVE: Obesidad mórbida, cirugía bariátrica. SUMMARYBackground: Surgery is the most effective treatment in the long run, for morbid obesity. Aim: To report the results of open bariatric surgery for morbid obesity in a regional public hospital. Material and methods: Prospective study of the first 100 patients aged 14 to 62 years (84% women) undergoing bariatric surgery in Coquimbo hospital between September 1998 and December 2005. A Horizontal Gastroplasty without gastric resection was done in 13 patients, a 6/7 Gastrectomy in 58 and a 9/10 Gastrectomy in 29. A gastric
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