Browsing by Author "Rebolledo Acevedo, Rolando"

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    Customized normothermic machine perfusion decreases ischemia–reperfusion injury compared with static cold storage in a porcine model of liver transplantation
    (2023) Riveros González, Sergio; Marino C., Carlo; Ochoa Suazo, Gabriela Susana; Soto Muñoz, Dagoberto Igor; Alegría Vargas, Leyla; Zenteno, María José ; San Martín, Sebastián; Brañes, Alejandro; Achurra Tirado, Pablo; Rebolledo Acevedo, Rolando
    Background: Liver transplantation has been demonstrated to be the best treatment for several liver diseases, while grafts are limited. This has caused an increase in waiting lists, making it necessary to find ways to expand the number of organs available for transplantation. Normothermic perfusion (NMP) of liver grafts has been established as an alternative to static cold storage (SCS), but only a small number of perfusion machines are commercially available. Methods: Using a customized ex situ machine perfusion, we compared the results between ex situ NMP and SCS preservation in a porcine liver transplant model. Results: During NMP, lactate concentrations were 80% lower after the 3-h perfusion period, compared with SCS. Bile production had a 2.5-fold increase during the NMP period. After transplantation, aspartate transaminase (AST) and alanine transaminase (ALT) levels were 35% less in the NMP group, compared to the SCS group. In pathologic analyses of grafts after transplant, tissue oxidation did not change between groups, but the ischemia–reperfusion injury score was lower in the NMP group. Conclusion: NMP reduced hepatocellular damage and ischemia–reperfusion injury when compared to SCS using a customized perfusion machine. This could be an alternative for low-income countries to include machine perfusion in their therapeutic options.
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    Self-Confidence on acquired surgical skills to deal with severe trauma patients in recently graduated surgeons
    (2022) Vela Ulloa, Javier; Cárcamo Gruebler, Leonardo; Contreras Bartolo, Caterina; Rebolledo Acevedo, Rolando; Varas Cohen, Julián; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Achurra Tirado, Pablo; Pontificia Universidad Católica de Chile. Escuela de Medicina
    Trauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old. Appropriate surgical skills are required to deal with these complex patients. Self-confidence to practice trauma procedures after the General Surgery Residency have not been reported in our country. Aim: Describe the level of self-confidence to deal with trauma procedures of surgeons who recently graduated from a General Surgery Residency. Method: Descriptive cross-sectional study. We designed and applied a survey in 2015, 2016 and 2017 to recently graduated surgeons, to inquire about self-confidence of surgical skills to deal with trauma scenarios. Eighteen trauma surgery procedures (including cervical, thoracic, abdominal and vascular procedures) were evaluated using a 5-grade Likert scale. The number of procedures performed during the residency was also queried. Results: Eighty-eight recently graduated surgeons from 11 different training programs in Chile were included. The report of competencies was high in procedures such as intestinal injuries, were 98% felt competent or very competent in their repair. On the other hand, in complex traumas such as major vessel injury, up to 76% reported not being competent. Self-confidence on procedures was directly associated with the number of procedures performed during residency. Conclusions: Recently graduated surgeons from General Surgery Programs report high levels of confidence to deal with low and intermediate complexity traumas, but a lower level of confidence to treat high complexity cases.