RESUMO Racional: Residência em Cirurgia Geral pode durar entre 2-6 anos, dependendo do país. Residência mais curta deve otimizar a exposição dos residentes às cirurgias. Sabe-se que o treinamento cirúrgico simulado encurta as curvas de aprendizado, mas a informação relacionada à como isso afeta a residência em relação à exposição clínica é escassa. Objetivo: Analisar o efeito da introdução de um programa de treinamento laparoscópico simulado validado em procedimentos abdominais realizados por residentes em um programa de Residência em Cirurgia Geral de três anos. Métodos: Um estudo de coorte não simultâneo foi desenhado. Quatro gerações (2012-2015) de cirurgiões graduados foram incluídos. Apenas os procedimentos abdominais em que os cirurgiões graduados foram o cirurgião principal foram descritos e analisados. O grupo controle foi de cirurgiões graduados de 2012 sem programa de treinamento laparoscópico simulado. Procedimentos cirúrgicos por ano de programa, técnica cirúrgica, intervenção de emergência ou eletiva e local do hospital (hospitais principais/comunitários) foram descritos. Resultados: Intervenções de 28 cirurgiões graduados foram analisadas (controle=5; programa de treinamento simulado=23). Os cirurgiões graduados realizaram média de 372 procedimentos abdominais, com maior número médio de procedimentos de médio a complexo no grupo de programa de treinamento simulado (48 vs. 30, p=0,02). Cirurgiões graduados treinados com programa de treinamento simulado realizaram número maior de procedimentos abdominais totais (384 vs. 319, p=0,04) e procedimentos laparoscópicos (183 vs. 148, p<0,05). Conclusões: A introdução do programa de treinamento laparoscópico simulado pode aumentar o número e a complexidade dos procedimentos totais e laparoscópicos na Residência em Cirurgia Geral de três anos.

ABSTRACT Background: A General Surgery Residency may last between 2-6 years, depending on the country. A shorter General Surgery Residency must optimize residents’ surgical exposure. Simulated surgical training is known to shorten the learning curves, but information related to how it affects a General Surgery Residency regarding clinical exposure is scarce. Aim: To analyze the effect of introducing a validated laparoscopic simulated training program in abdominal procedures performed by residents in a three-year General Surgery Residency program. Methods: A non-concurrent cohort study was designed. Four-generations (2012-2015) of graduated surgeons were included. Only abdominal procedures in which the graduated surgeons were the primary surgeon were described and analyzed. The control group was of graduated surgeons from 2012 without the laparoscopic simulated training program. Surgical procedures per program year, surgical technique, emergency/elective intervention and hospital-site (main/community hospitals) were described. Results: Interventions of 28 graduated surgeons were analyzed (control group=5; laparoscopic simulated training program=23). Graduated surgeons performed a mean of 372 abdominal procedures, with a higher mean number of medium-to-complex procedures in laparoscopic simulated training program group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic simulated training program performed a higher number of total abdominal procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148, p<0.05). Conclusions: The introduction of laparoscopic simulated training program may increase the number and complexity of total and laparoscopic procedures in a three-year General Surgery Residency.

Cases of intravenous leiomyoma with intracardiac extension are rare. Patients with signs of right-sided overload who present symptoms of acute heart failure and whose symptoms do not improve with conventional management, we must consider this entity. It is important to comprehensively assess with imaging studies such as electrocardiogram, echocardiogram, Tomography (CT scan) or magnetic resonance. The following is a report of the case of a 46 year old woman with symptoms of acute heart failure and inadequate response to conventional drugs. The echocardiographic show findings of a tumor in the right atrium, protruding to the right ventricle causing tricuspid regurgitation. The CT scan confirmed the extent of the tumor to the inferior vena cava and right ventricle, and was resolved surgically with radical resection and histology lineage confirmed by pathologic examination.

Son raros los casos de leiomiomas intravenosos con extensión intracardiaca. En pacientes con manifestaciones de sobrecarga de cavidades derechas o quienes debutan con síntomas de insuficiencia cardiaca aguda y cuyos síntomas no mejoran con el manejo convencional, se debe considerar esta entidad, y es importante evaluar de forma integral con estudios de gabinete como electrocardiograma, ecocardiograma, tomografía o resonancia magnética. Reportamos el caso de una mujer de 46 años que manifiesta síntomas de insuficiencia cardiaca aguda e inadecuada respuesta a los fármacos convencionales. Con hallazgos ecocardiográficos de tumoración en atrio derecho que protruye a ventrículo derecho y causa insuficiencia tricuspídea. Por estudio tomográfico se confirma la extensión del tumor a vena cava inferior y ventrículo derecho; se resuelve de forma quirúrgica con resección radical y se confirma la extirpación histológica mediante estudio anatomopatológico.

El venado cola blanca es una especie con una gran plasticidad conductual y de adaptación en diferentes hábitat. En el Parque Sierra Nanchititla en el Estado de México se realizó un estudio para determinar los hábitos alimentarios en el bosque mesófilo de montaña (BMM) y bosque de pino-encino (BPE). De junio 1990 a mayo 1992 se recolectaron 104 muestras de excremento de venado en las dos zonas de estudio. Aplicamos el índice de Morisita y la correlación de Spearman para determinar la preferencia alimentaria. Se utilizó el análisis histológico de heces fecales para herbívoros las cuales se compararon con muestras de tejidos vegetales de plantas de la zona de estudio. Los resultados muestran que consume el 79.44% de especies vegetales del BMM y 20.56% del BPE. Existe cierta tendencia en la selectividad de 12 de las 14 especies de plantas localizadas en el BMM, mientras que para el BPE no se aprecia tal tendencia. Las especies clave que for- man parte de la alimentación elemental del venado fueron: Acalypha setosa, Smilax pringlei, Psidium sartorianum y Dendropanax arborea. El consumo de plantas no varió sig- nificativamente entre la época seca y lluviosa en función de la forma biológica (X2=12, p=0.21). Sin embargo, durante la época seca existe cierta tendencia a consumir árboles y a finales de la época de lluvia a consumir hierbas (Z=1.61, p=0.95). Los datos indican que el venado puede ser selecti- vo con plantas del BMM, mientras que para el BPE tiende a ser oportunista.

Food habits of the white-tailed deer, Odocoileus virginianus (Artiodactyla: Cervidae) in Nanchititla Natural Park, Mexico. White-tailed deer is a species with a large behavioral plasticity and adapta- tion to different habitats, including their food habits. This study was conducted with the aim to determine the food habits of this species in the cloud (BMM) and pine-oak (BPE) forests. Deer scats and plant samples were obtained following standard methods, from Sierra Nanchititla Park in the State of Mexico, from June 1990 to May 1992. A total of 104 deer pellet-groups were collected, and histological analysis for herbivores was used and compared with stock samples of plant tissues collected from the study area. We applied the Spearman correlation and Morisita index to determine alimentary preference. The results showed that the deer consumes 79.44% of plant species from BMM and 20.56% of the BPE. There is a selectivity tendency for 12 of the 14 plant species located in the BMM, while for BPE no tendency was observed. Key species that are part of the elemental diet of the deer in these areas were: Acalypha setosa, Smilax pringlei, Psidium sartorianum and Dendropanax arborea. The consumption of plants did not differ significantly between the dry and rainy seasons in terms of biological form, however, during the dry season there is a tendency to consume trees, and by the end of the rainy season to consume herbs. The data indicate that the deer can be selective with BMM plants, while for the BPE tends to be opportunistic.