1,720,998 research outputs found
Chirurgia : il filo di Arianna : casi clinici didattici per gli studenti del corso di laurea in Medicina e chirurgia
No full textIl libro contiene casi clinici di chirurgia adatti allo sviluppo del senso clinico dello studente degli ultimi anni di medicina e chirurgi
LA TECNICA DI LICHTENSTEIN PER LA RIPARAZIONE DELL’ERNIA INGUINALE MONOLATERALE PRIMITIVA
No full textPremessa - L’ernioplastica protesica in anestesia locale è attualmente considerata il gold standard nel trattamento delle ernie inguinali primitive monolaterali. Tuttavia ancora si discute sul tipo di tecnica e soprattutto sul recupero post-operatorio.
Scopo del lavoro - Riportare 15 anni di esperienza nella riparazione dell’ernia inguinale primitiva monolaterale con tecnica di Lichtenstein in 1.172 pazienti di sesso maschile con un follow-up minimo di 1 anno.
Metodi - Dal marzo 1990 al dicembre 2005, sono stati sottoposti ad intervento chirurgico 1.172 pazienti di sesso maschile affetti da ernia inguinale monolaterale primitiva con un’età media di 59,4 anni (range: 16-97): 476 pazienti (40,6%) avevano più di 65 anni e 60 (5,1%) più di 80. La durata dei sintomi prima dell’intervento chirurgico è stata in media di 3,7 anni (range: 0,1-4,9). In 31 casi (2,7%) l’ernia era incarcerata e in 3 (0,3%) strozzata. In 539 pazienti (46%) erano presenti una o più comorbilità. Tutti i pazienti sono stati sottoposti in anestesia locale ad ernioplastica protesica anteriore con la tecnica di Lichtenstein. Gli interventi eseguiti da un chirurgo esperto sono stati 938, mentre i restanti sono stati eseguiti da specializzandi di qualunque anno di corso sotto la supervisione di un tutor specialista.
Risultati - Nel periodo perioperatorio non vi sono state complicanze maggiori. Complicanze generali (18 episodi di reazione vaso-vagale, 3 ritenzioni urinarie acute e 1 iperpiressia di origine ignota) sono insorte in 22 pazienti (1,9%), mentre quelle locali (10 ematomi, 8 infezioni superficiali, 2 edemi scrotali e 1 sieroma) in 21 (1,8%). Dolore post-operatorio precoce significativo è stato registrato in 13 pazienti (1,1%) che hanno richiesto un supplemento di analgesici oppioidi, mentre non vi sono stati casi di dolore cronico o a lungo termine. La quasi totalità dei pazienti è stata dimessa il giorno stess o il giorno successivo all’intervento. Un prolungamento della degenza si è reso necessario in 27 casi per complicanze generali e/o locali o dolore. Al follow-up sono stati registrati 5 casi di recidiva erniaria (0,4%) la cui incidenza è risultata sovrapponibile per gli interventi eseguiti da un chirurgo esperto e da uno specializzando.
Conclusioni - La rapida ripresa delle normali attività, l’assenza di complicanze maggiori sia generali sia addominali, la bassa incidenza di complicanze locali unitamente ai costi contenuti supportano la scelta di utilizzare la tecnica di Lichtenstein per il trattamento delle ernie inguinali primitive monolaterali
Grasp laparoscopic surgery basic skills: A highly interactive online course model here
No full textRecent changes in surgical education and training have made the virtual learning environments more attractive than previously and have created opportunities for new instructional designs of medical curricula. The aim of this project is to show the results of a novel online elective programme to complement existing surgical undergraduate teaching methods. The training process was developed to enhance existing skills in the field of minimally invasive surgery among the students of the Bachelor Degree in Medicine and Surgery. Interventions were provided characterised on the one hand by the high quality of content and teaching methods, on the other hand by the strong interaction between teachers and students. The elective course created was delivered entirely online, password-protected, and was divided into 4 modules. 30 students enrolled in the fifth and sixth-year students of the UNIGE medical schools have significantly improved their knowledge on mini-invasive surgery after the course. The evaluation results demonstrated high levels of course functionality, effectiveness of its online content and high levels of satisfaction among medical students
The medical point of view into a simulation project of management for safety and security in disasters and emergencies of industrial plants (Diem-Ssp Project)
No full textIndustrial mass casualty incidents are an unfortunate reality in the 21st century, but there are few situational training exercises to prepare and to cope with emergencies management. The Authors realized a project to carry out development of the activities devoted to face the complexities arising from emergencies in industrial plants. The DIEM-SSP is a simulation project working on two interoperable simulators, based on the IEEE 1516 High Level Architecture (HLA), used as test-bed on specific case studies. The project is aimed to study innovative emergency procedures and proper routing of critical patients with severe traumas toward the most suitable first aid facilities. The project takes into account the emergency procedures considering the human factor and the possibility of mistakes. It is aimed to test and validate these methodologies through a test-bed based on distributed and interoperable simulation. The Authors report the medical contribution in this project
The medical point of view into a simulation project of management for safety and security in disasters and emergencies of industrial plants (Diem-Ssp Project)
No full textIndustrial mass casualty incidents are an unfortunate reality in the 21st century, but there are few situational training exercises to prepare and to cope with emergencies management. The Authors realized a project to carry out development of the activities devoted to face the complexities arising from emergencies in industrial plants. The DIEM-SSP is a simulation project working on two interoperable simulators, based on the IEEE 1516 High Level Architecture (HLA), used as test-bed on specific case studies. The project is aimed to study innovative emergency procedures and proper routing of critical patients with severe traumas toward the most suitable first aid facilities. The project takes into account the emergency procedures considering the human factor and the possibility of mistakes. It is aimed to test and validate these methodologies through a test-bed based on distributed and interoperable simulation. The Authors report the medical contribution in this project
Construction and validation of a low-cost laparoscopic simulator
No full textINTRODUCTION. To present the University of Genoa Advanced Simulation Center (ASC) and the design a trainer (eLap4D) that would achieve the equivalent goals of the fundamentals of laparoscopic surgery trainer at an economical cost. The validation process is going to be shown too. METHODS. The laparoscopic trainer is a physical low-cost laparoscopic training platform that reproduces the tactile feedback (eLaparo4d) integrated with a software for virtual anatomical realistic scenarios (Unity3D V 4.1). A sample of 20 students was selected, divided into 2 homogeneous groups with respect to the level of confidence with the use of video games, consolles, smartphones (this has been possible thanks to the use of a questionnaire, administered before the practical phase of training). The groups participated in a training program based on 5 basic laparoscopic skills (laparoscopic focusing and navigation, hand - eye - coordination and grasp coordination). So, a second and third study sample was chosen, consisting of 20 post graduate students (intermediate group) and 20 experienced surgeons; for theese groups was provided a training program identical to the previous group as well as their subdivision into 2 group. The face validity was used for an ergonomic analysis of the simulator, the construct to test the system's ability to differentiate potential expert users (experienced surgeons) from non-experts (student without experience in laparoscopic surgery). RESULTS. We analyzed the results of the three samples obtained by comparing variables such as: score % of fullfillment panality time At the same time, the students' improvements have been monitored, developing a customized learning curve for each user. To evaluate the structural characteristics of the simulator a specific questionnaire has been used. The results encouraged us. The simulator is ergonomically satisfactory and its structural features are adapted to the training. The system was able to differentiate the level of experience and also has therefore met the requirements of "construct validity". CONCLUSION. Valid laparoscopic simulators can be constructed at an economical cost
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