Pereira Junior GA, Carmo ACFD, Neves JC
… +1 more, Colleoni Neto R
Rev Col Bras Cir
· 2025 · PMID 39841724
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This article celebrates the 50th anniversary of the continuous publication of the Journal of the Brazilian College of Surgeons (RCBC), revisiting its trajectory from the beginning to the present day. RCBC has evolved fro...This article celebrates the 50th anniversary of the continuous publication of the Journal of the Brazilian College of Surgeons (RCBC), revisiting its trajectory from the beginning to the present day. RCBC has evolved from a nationally relevant publication to a journal with international impact, constantly adapting to changes in editorial and scientific practices. This article presents an analysis of the major milestones, editorial changes, and innovations that have cemented RCBC as a prominent scientific vehicle. In addition, it discusses future strategies to maintain editorial quality and increase the visibility of the journal in the global scientific scenario.
Rev Col Bras Cir
· 2025 · PMID 39841723
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This article shows the most recent data on the evolution of the number of resident physicians and vacancies from R1 to R5, as well as the number of programs and institutions accredited by the National Commission for Medi...This article shows the most recent data on the evolution of the number of resident physicians and vacancies from R1 to R5, as well as the number of programs and institutions accredited by the National Commission for Medical Residency (CNRM). It also discusses the types and modalities of evaluation of medical residency, with a focus on the assessment of competencies throughout in-service training, which were incorporated into the most recent CNRM resolution, at the end of 2023, which amended and updated the 2006 directives. Finally, it shows the experience of six Medical Societies that conduct periodic evaluation of resident physicians, presented at a Brazilian Medical Association event.
Rev Col Bras Cir
· 2025 · PMID 39841722
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The authors debate the arguments presented in the editorial "Reflections on the current context and evaluation of undergraduate medical education", bringing the context that culminated in the recent application of the Na...The authors debate the arguments presented in the editorial "Reflections on the current context and evaluation of undergraduate medical education", bringing the context that culminated in the recent application of the National Proficiency Exam in Dentistry.
Pereira Júnior GA, Colleoni Neto R, Alves R
… +5 more, Guedes HTV, Guedes JC, Hamamoto Filho PT, Dolci JEL, Fernandes CE
Rev Col Bras Cir
· 2025 · PMID 39841721
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This reflection article can be divided into two complementary parts. The first shows the current context of medical education in Brazil, bringing the most recent data on the number of undergraduate students and its growi...This reflection article can be divided into two complementary parts. The first shows the current context of medical education in Brazil, bringing the most recent data on the number of undergraduate students and its growing gap in relation to the reduced number of vacancies in medical residency, which, despite being the most appropriate modality to train specialists, has been overlooked by the excessive number of lato sensu graduate courses. The second part discusses the possibilities of evaluating medical training, which is terminal in Brazil, enabling the newly graduated physician to claim the professional registration and to practice medicine, being evaluated only by their own medical course. It also reviews the historical evolution and pros and cons of evaluating medical education for doctors trained both locally and abroad.
Rev Col Bras Cir
· 2025 · PMID 39841720
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INTRODUCTION: Advances in imaging methods have led to an increasingly frequent diagnosis of adrenal gland lesions as incidental findings. Despite progress in this field, there is still limited information regarding the e...INTRODUCTION: Advances in imaging methods have led to an increasingly frequent diagnosis of adrenal gland lesions as incidental findings. Despite progress in this field, there is still limited information regarding the epidemiology of the clinical and metabolic profile of patients with adrenal incidentaloma (AI). The objective is analyze the epidemiology of adrenal tumors at Gaffrée e Guinle University Hospital (HUGG) and compare it with data from the literature. METHOD: This is a cross-sectional study that included patients of any gender and age who was treated at HUGG for adrenal tumors. RESULTS: The following variables were evaluated: age, gender, functionality, benignity, and size. We also analyzed the metabolic profile of patients with AI, specifically those with mild autonomy cortisol secretion. Out of 31 patients with adrenal tumors, 68% were female. The mean age was 55 years with a standard deviation of ±16.2. 54% of the sample had adrenal incidentalomas. 93.6% of the sample had benign cases. Among the adrenal incidentalomas, 53% were non-functioning. In patients with adrenal tumors, only 10% had metabolic syndrome, while in patients with mild autonomous cortisol secretion, this number rose to 17%. CONCLUSION: The sample of patients with adrenal tumors and incidentaloma at HUGG presented a prevalence of metabolic complications similar to that found in the literature.
Rev Col Bras Cir
· 2025 · PMID 39813423
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The article by Sweigart et al. presents concerns, challenges, and proposals for the current situation, both nationally and internationally, and the need for a diversity of medical care practice scenarios that simultaneou...The article by Sweigart et al. presents concerns, challenges, and proposals for the current situation, both nationally and internationally, and the need for a diversity of medical care practice scenarios that simultaneously develop teaching abilities. Medical education is now conducted outside the university-affiliated teaching hospital, often in the so-called community or general hospitals dedicated to patient care. In Brazil, most of these hospitals are under municipal or state management.
Rev Col Bras Cir
· 2025 · PMID 39813421
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We discuss the arguments exposed in the Letter to the Editor "Reflections on the Inclusion of Direct-Care Physicians as Educators in Community Hospitals", exploring the teaching competencies necessary for community prece...We discuss the arguments exposed in the Letter to the Editor "Reflections on the Inclusion of Direct-Care Physicians as Educators in Community Hospitals", exploring the teaching competencies necessary for community preceptors in the context of medical education, highlighting the growing responsibility of these professionals in the training of future physicians in health-deprived regions. From a narrative review, we analyze faculty development (FD) programs, emphasizing their importance in improving teaching skills, creating support networks, and providing personalized content for specific challenges. Among the competence domains identified are teaching skills, evaluation criteria, professionalism, communication, and leadership/management. In addition, we suggest Entrustable Professional Activities (EPA) as tools to assess and develop these competencies. FD programs, when well structured, benefit preceptors, students, and communities, improving the quality of teaching and care outcomes.
Santos Neto RSD, Bruginski D, Volkmann AF
… +1 more, Moura Neto JA
Rev Col Bras Cir
· 2025 · PMID 39813420
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This paper discusses the increasing trend of direct-care physicians taking on teaching roles in community hospitals, both in the United States and Brazil. It highlights the challenges faced by these physicians, who often...This paper discusses the increasing trend of direct-care physicians taking on teaching roles in community hospitals, both in the United States and Brazil. It highlights the challenges faced by these physicians, who often lack formal pedagogical training and dedicated time for teaching. The text emphasizes the need for structured support, faculty development programs, and collaboration with academic centers to ensure the quality of education in these settings. It also underscores the potential benefits of this model, such as increased access to medical training in underserved areas and a more hands-on learning experience for students. Overall, the document calls for a thoughtful and comprehensive approach to integrating direct-care physicians as educators, ensuring that this practice benefits both the physicians themselves and the quality of medical education.
Rev Col Bras Cir
· 2025 · PMID 39813418
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Robotic surgery is a technological milestone that directly impacts the provision of healthcare services. Procedures that utilize robotics are continuously being developed. In this context, it is important to analyze the...Robotic surgery is a technological milestone that directly impacts the provision of healthcare services. Procedures that utilize robotics are continuously being developed. In this context, it is important to analyze the distribution of ethical and civil liability among doctors, hospitals, and suppliers of surgical equipment in cases of alleged medical errors or adverse events that may harm patients. This review aims to examine the civil and ethical liability of the parties involved in robotic surgeries, as well as possible means to avoid legal complications related to these procedures concerning the Medical Councils and the judicial system.
Rev Col Bras Cir
· 2025 · PMID 39813417
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INTRODUCTION: Hemorrhage is the leading cause of preventable deaths in trauma patients, resulting in 1.5 million deaths annually worldwide. Traditional trauma assessment follows the ABC (airway, breathing, circulation) s...INTRODUCTION: Hemorrhage is the leading cause of preventable deaths in trauma patients, resulting in 1.5 million deaths annually worldwide. Traditional trauma assessment follows the ABC (airway, breathing, circulation) sequence; evidence suggests the CAB (circulation, airway, breathing) approach to maintain perfusion and prevent hypotension. Damage Control Resuscitation (DCR), derived from military protocols, focuses on early hemorrhage control and volume replacement to combat the "diamond of death" (hypothermia, hypocalcemia, acidosis, coagulopathy). This study evaluates the implementation of DCR protocols in Brazilian trauma centers, hypothesizing sub-optimal resuscitation due to high costs of necessary materials and equipment. METHODS: In 2024, an electronic survey was conducted among Brazilian Trauma Society members to assess DCR practices. The survey, completed by 121 participants, included demographic data and expertise in DCR. RESULTS: All 27 Brazilian states were represented in the study. Of the respondents, 47.9% reported the availability of Massive Transfusion Protocol (MTP) at their hospitals, and only 18.2% utilized whole blood. Permissive hypotension was practiced by 84.3%, except in traumatic brain injury cases. The use of tranexamic acid was high (96.7%), but TEG/ROTEM was used by only 5%. For hemorrhage control, tourniquets and resuscitative thoracotomy were commonly available, but REBOA was rarely accessible (0.8%). CONCLUSION: Among the centers represented herein, the results highlight several inconsistencies in DCR and MTP implementation across Brazilian trauma centers, primarily due to resource constraints. The findings suggest a need for improved infrastructure and adherence to updated protocols to enhance trauma care and patient outcomes.
Rev Col Bras Cir
· 2024 · PMID 39630756
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INTRODUCTION: The Karnofsky Performance Status (KPS) is one of the most widely used tools for assessing the prognosis of oncology patients, providing an estimate of treatment efficiency and survival. Despite this, it is...INTRODUCTION: The Karnofsky Performance Status (KPS) is one of the most widely used tools for assessing the prognosis of oncology patients, providing an estimate of treatment efficiency and survival. Despite this, it is commonly used in free translations without validation. The objective of the present study was to perform the cross-cultural adaptation of the KPS instrument to Brazilian Portuguese (KPS-BR) through the stages of conceptual, semantic, operational, measurement, and functional equivalences. METHODS: To assess consistency, we used Cronbach's alpha and kappa coefficients. The Chi-square test was performed to evaluate the association between scores and the number of deaths. The relationship with survival and mortality was explored with Kaplan-Meier curves. RESULTS: A total of 316 patients participated in the study. The internal consistency analysis resulted in a Cronbach's alpha coefficient of 0.9265. For the inter-rater analysis, the correlation coefficient was 1, as was the kappa coefficient, indicating perfect agreement between observers. The correlation coefficient between the KPS-BR scale in the test-retest was 0.8631. We observed a 100% death rate at KPS-BR scale score 20 and a gradual decrease as the KPS-BR scale score increases up to KPS-BR 40 (p<0.0001). Estimation of survival using the Kaplan-Meier method demonstrated an association between KPS-BR scale scores and survival (p<0.0001). CONCLUSION: The KPS-BR scale showed reliability and validity for the prognostic assessment of cancer patients, demonstrating a correlation with survival.
Rev Col Bras Cir
· 2024 · PMID 39630755
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INTRODUCTION: Obesity has been increasing at alarming rates in Brazil and worldwide. It is known that bariatric surgery is an effective and safe treatment for severely obese adults with related comorbidities or morbidly...INTRODUCTION: Obesity has been increasing at alarming rates in Brazil and worldwide. It is known that bariatric surgery is an effective and safe treatment for severely obese adults with related comorbidities or morbidly obese individuals. Among the various comorbidities, chronic low back pain is one of the major sources of discomfort and reduced quality of life in these patients. Studies that investigate the impact of bariatric surgery on the lives of obese individuals with chronic low back pain are scarce. METHODS: We analyzed 38 patients who were obese grade 3 or severely obese grade 2 and suffered from chronic low back pain. These patients underwent bariatric surgery. Eight variables were assessed before the surgery and 6 months post-surgery, comprising 5 quantitative variables and 3 qualitative variables. RESULTS: Paired t-tests were used for the statistical analysis of quantitative variables. The mean values of interleukin-6 before the surgery did not differ statistically from post-operative measurements. However, the values of C-reactive protein, weight, BMI, and Oswestry Disability Index 2.0 were all statistically different post-operatively. As for qualitative variables, the 3 variables analyzed using the Wilcoxon test showed statistically significant differences. CONCLUSION: Substantial reduction in weight following bariatric surgery may be associated with significant reductions in chronic low back pain in the early post-operative period. This effect could result from an overall improvement in well-being associated with weight loss but may also be associated with a reduction in inflammatory factors, as indicated by the decrease in C-reactive protein, although not confirmed by interleukin-6.
Rev Col Bras Cir
· 2024 · PMID 39607186
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INTRODUCTION: All forms of access to the peritoneal cavity in laparoscopy could damage intra-abdominal structures. Currently, ultrasound (USG) is being used in several procedures to guide needles: breast biopsy, central...INTRODUCTION: All forms of access to the peritoneal cavity in laparoscopy could damage intra-abdominal structures. Currently, ultrasound (USG) is being used in several procedures to guide needles: breast biopsy, central venous access puncture, anesthetic nerve blocks, etc. Therefore, this research seeks to verify the feasibility and viability of performing pneumoperitoneum using USG-guided puncture in a pilot study using a porcine model. METHODS: The cross-sectional study was carried out with a sample of 10 anesthetized sows in the IRCAD-América Latina Barretos Unit laboratory. The experiment consisted of an abdominal puncture guided by USG with a linear transducer to create the pneumoperitoneum. After the puncture, the drop test was performed, and CO2 was insufflated into the cavity. Subsequently, a 10mm trocar was introduced to insert the optic. The parameters from the USG were the thickness of the abdominal wall layers, intraperitoneal needle measurement, drop test, and the presence of complications. RESULTS: The average measurement of the layers was 0.45 centimeters of subcutaneous tissue, 0.67 centimeters of muscle, and 0.15 centimeters of peritoneum. The mean measurement of the intraperitoneal needle was 1.17cm. Furthermore, the drop test was positive in 100% of cases, and there was no bleeding or lesions on any attempt. CONCLUSION: Ultrasound-guided pneumoperitoneum is feasible and safe in the porcine model. The subcutaneous, muscular, and peritoneum layers are identifiable and measurable in this model. Subsequent studies are necessary to verify the importance of this new procedure.