Background: Glioblastoma multiforme (GBM) owes an ominous prognosis: its mean overall survival is 14 months. The extent of surgical resection (ESR) highlights among factors in which an association has been found to a somewhat better prognosis. However, the association between greater ESR and prolonged overall (OS) survival is not a constant finding nor a proven cause-and-effect phenomenon. To our objective is to establish the strength of association between ESR and OS in patients with GBM through a systematic review and meta-analysis. Methods: In accordance with PRISMA-P recommendations, we conducted a systematic literature search; we included studies with adult patients who had undergone craniotomy for GBM. Our primary outcome is overall postoperative survival at 12 and 24 months. We reviewed 180 studies, excluded 158, and eliminated 8; 14 studies that suited our requirements were analyzed. Results: The initial level of evidence of all studies is low, and it may be degraded to very low according to GRADE criteria because of design issues. The definition of different levels of the extent of resection is heterogeneous and poorly defined. We found a great amount of variation in the methodology of the operation and the adjuvant treatment protocol. The combined result for relative risk (RR) for OS for 12 months analysis is 1.25 [95% confidence interval (95% CI) 1.14–1.36, P < .01], absolute risk reduction (ARR) of 15.7% (95% CI 11.9–19.4), relative risk reduction (RRR) of 0.24 (95% CI 0.18–0.31), number needed to treat (NNT) 6; for 24-month analysis RR is 1.59 (95% CI 1.11–2.26, P < .01) ARR of 11.5% (95% CI 7.7–15.1), relative risk reduction (RRR) of 0.53 (95% CI 0.33–0.76), (NNT) 9. In each term analysis, the proportion of alive patients who underwent more extensive resection is significantly higher than those who underwent subtotal resection. Conclusion: Our results sustain a weak but statistically significant association between the ESR and OS in patients with GBM obtained from observational studies with a very low level of evidence according to GRADE criteria. As a consequence, any estimate of effect is very uncertain. Current information cannot sustain a cause-and-effect relationship between these variables.

Morphea, or localized scleroderma, is a rare disease of the connective tissue that manifests itself with localized sclerosis of the skin and, in some cases, with extracutaneous manifestations. Its etiology is not fully understood, but it is believed that there is genetic predisposition, in addition to environmental triggering factors. Classification of the disease is not simple due to its multiple presentations; however, it is useful in order to define the treatment, which should be individualized and started early to avoid cosmetic and functional complications. In this review, we summarize the most important practical aspects of the classification, diagnostic methods and evaluation of morphea activity, as well as available therapeutic options, with an emphasis on existing clinical evidence regarding their efficacy and safety.

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Objective:The aim of the study was to determine the burnout syndrome's prevalence in surgeons, surgery residents and medical students in a private institution using the Maslach Burnout Inventory and to analyze associated factors related to the presence of this syndrome. Materials and methods: Once approved by the Ethics and Research Committee from our Institution, the Maslach Burnout Inventory was used to identify the presence of burnout syndrome in a sample of 72 physicians at the surgery service. The diagnosis of burnout syndrome was defined as the association of a high level of emotional exhaustion and depersonalization with a low level of professional achievement. Its prevalence was determined and an analysis of demographic factors and bioethical training was performed. The relationship of these factors was examined concerning the syndrome's presence or absence, using Fisher's exact test, Chi-square, and Mann-Whitney U-test. Finally, a logistic univariate and multivariate regression analysis applied. Results: A 65% (Confidence interval 95% 54-76) burnout syndrome global prevalence was found. The prevalence found in medical students was 67%, in surgery residents 76%, and in surgeons 45.5%. Statistical significance was found between the absence of the syndrome and bioethics training (p = 0.000), presence of burnout syndrome, age (higher risk in young people, p = 0.020), and working hours per week (higher risk in subjects with higher workload p = 0.034). No statistical relationship was observed between the burnout syndrome and the gender or the medical position. Conclusions: High burnout syndrome prevalence was found in the medical population from the department of surgery at our institution. This study suggests that the proper knowledge of bioethical aspects in the practice of medicine is a cardinal element that protects against the development of burnout syndrome. The present study points toward an appropriate bioethics training as a preventive factor of the burnout syndrome.

Fluoroscopy-guided radiofrequency thermocoagulation of the trigeminal ganglion is an alternative treatment for symptomatic trigeminal neuralgia. The most common complications of the procedure are circumscribed to sensitivity alterations. We report a case of an 83-year-old female patient with a history of petroclival meningioma resection, radiotherapy at the level of the petrous apex, and radiofrequency thermocoagulation for trigeminal neuralgia who developed a symptomatic dural arteriovenous fistula as an early complication, which required selective embolization. Dural arteriovenous fistula as an immediate complication of percutaneous thermocoagulation of the trigeminal ganglion has not been previously reported.