We found that psoriatic lesions occurred predominantly in adult patients with Crohn's disease who received infliximab and had no previous history of psoriasis. Most patients can be managed conservatively without discontinuing anti-TNF-α therapy.

Juvenile hyaline fibromatosis (JHF) and infantile systemic hyalinosis (ISH) are rare, autosomal recessive disorders of the connective tissue caused by mutations in the gene encoding the anthrax toxin receptor 2 protein (ANTXR2) located on chromosome 4q21. Characteristically, these conditions present with overlapping clinical features, such as nodules and/or pearly papules, gingival hyperplasia, flexion contractures of the joints, and osteolytic bone defects. The present report describes a pair of sibs and three other JHF/ISH patients whose diagnoses were based on typical clinical manifestations and confirmed by histopathologic analyses and/or molecular analysis. A comparison of ISH and JHF, additional thoughts about new terminology (hyaline fibromatosis syndrome) and a modified grading system are also included.

Due to ethical and legal aspects involved in the handling of cadavers and animals the synthetic simulators are an alternative for learning how to suture technique plus the practice of various procedures such as incision and surgical flap. In this context, this paper describes and propose the use of a synthetic model manufactured from plates of ethylene-vinyl acetate (EVA) to teach primary surgical skills in medical students with no previous exposure to surgery. The model that provides the convenience of being easily reproducible, allowing the students in training can thus improve their skills before applying the technique in clinical practice. Key words: Education, Medical. Students, Medical. Teaching. Surgery. Sutures. RESUMODevido aos aspectos éticos e legais envolvidos no manuseio de cadáveres e animais, os simuladores sintéticos surgem como alternativa para o ensino-aprendizagem de técnicas de sutura e simulação de procedimentos, como a confecção de incisões e retalhos cirúrgicos. Neste âmbito é proposto e descrito um modelo de bancada sintético confeccionado a partir de etileno vinil acetato (EVA) para o ensino de habilidades cirúrgicas básicas, em estudantes de medicina sem exposição prévia a cirurgia. O modelo fornece a praticidade de ser reprodutível, barato e de fácil aquisição, possibilitando que o acadêmico em formação possa, portanto, aperfeiçoar suas habilidades antes de aplicar a técnica na prática clínica. Descritores: Educação Médica. Estudantes de Medicina. Ensino. Cirurgia. Suturas. -Acta Cirúrgica Brasileira -Vol. 26 (2) 2011Bastos EM et al.

PURPOSE:To propose an organic bench model made with fruits/vegetables as an alternative to complement the arsenal of simulators used in the teaching and learning of basic surgical skills during medical graduation and education. METHODS: They were described the training strategies, through the use of fruits (or vegetables) to the learning of different techniques of incision, sutures, biopsies and basic principles of reconstruction. The preparation of bench model, the processes of skill acquisition, feedback and evaluation were also delineated. RESULTS:A proposal for teaching based on an organic model with training delivered in multiple sessions, with increasing levels of difficulty, and with feedback and evaluation during all the process was structured. CONCLUSION:The organic model, being simple, versatile, portable, reproducible, readily available, and having low cost, is another option to complement the existing simulators for teaching and learning of basic surgical skills.Key words: Surgery. Education. Teaching Materials. Models, Educational. Learning. Training. RESUMOOBJETIVO: Propor um modelo de bancada orgânico, confeccionado com legumes/frutas, como alternativa para complementar o arsenal de simuladores aplicados no ensino-aprendizagem das competências cirúrgicas básicas durante a graduação e o ensino médico. MÉTODOS:Foram descritas as estratégias de treinamento, através da utilização de frutas (ou legumes), para a aprendizagem de diferentes técnicas de incisão, suturas, biópsias e princípios básicos de reconstrução. A preparação do modelo de bancada, os processos de aquisição de habilidades e feedback e os métodos deavaliação também foram delineados. RESULTADOS:Estruturou-se uma proposta de ensino baseada em um modelo orgânico com o treinamento distribuído em várias sessões, com níveis crescentes de dificuldade e com feedback e avaliação de todo o processo. CONCLUSÃO:O modelo orgânico, por ser simples, versátil, portátil, reprodutível, disponível, de fácil aquisição e baixo custo é mais uma opção para complementar o arsenal de simuladores de ensino e aprendizagem existentes.Descritores: Cirurgia. Educação. Materiais de Ensino. Modelos Educacionais. Aprendizagem. Capacitação. Organic bench model to complement the teaching and learning on basic surgical skills

Although extremely rare, the presence of ectopic thyroid tissue in the submandibular region should be considered in the differential diagnosis of tissue masses in the cervical region. Diagnosis is confirmed by fineneedle aspiration biopsy and exclusion of malignancy should be confirmed by histopathologic analysis of the lesion. In general, surgery is the treatment of choice. A rare case of ectopic thyroid in the right submandibular region is reported; it was diagnosed after total thyroidectomy and successfully treated through surgery.

The mandibular proximal ramus segments should be moved and rotated during orthognathic surgery-based skeletofacial reconstruction for the correction of challenging patients with facial asymmetry and malocclusion, but quantitative data regarding this rotation were not sufficient to date. This 3D computer-assisted study measured the proximal ramus segment rotation after 3D simulation-guided two-jaw surgery in patients with facial asymmetric deformity and class III malocclusion (n = 31). Using 3D mandible models and a reliable proximal ramus segment-related plane, angular changes in pitch, roll and yaw directions were measured before and one month after surgery. Significant rotational changes (p < 0.01) were observed in the left and right sides and overall proximal ramus segments after surgery, with absolute differences of 4.1 ± 3.0 (range −7.8 to 6.9), 2.8 ± 2.3 (−8.8 to 5.0), and 2.7 ± 2.4 (−6.6 to 9.9) degrees in pitch, roll, and yaw rotations, respectively. Numbness and mouth opening limiting occurred within the first 6 months after surgery but the patients had an unremarkable long-term postoperative course, with no revisionary surgery required. This study contributes to the multidisciplinary-related literature by revealing that proximal ramus segment rotation and rigid fixation with no postoperative intermaxillary immobilization was practicable in skeletofacial surgery for the successful treatment of asymmetric deformity and class III malocclusion.

It is remarkable the reduction in the number of medical students choosing general surgery as a career. In this context, new possibilities in the field of surgical education should be developed to combat this lack of interest. In this study, a program of surgical training based on learning with models of low-fidelity bench is designed as a complementary alternative to the various methodologies in the teaching of basic surgical skills during medical education, and to develop personal interests in career choice.

Background:The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals.Aims:To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students.Materials and Methods:Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills’ training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs’ skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances.Results:The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills’ training) was considered large (>0.80) in all measurements.Conclusion:The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials.