Tratamiento quirúrgico del divertículo de Zenker; un caso clínico; Hospital Militar Central de La Paz (COSSMIL) gestión 2022 / Surgical treatment of Zenker's diverticulum, a Clinical Case Central Military Hospital of La Paz (COSSMIL) gestión 2022

Se presenta un caso clínico de una paciente de 66 años de edad masculino que acude a nuestro hospital (COOSMIL), después de hacer una anamnesis donde el paciente manifiestas molestias como tos, regurgitación y mal alientos (halitosis) y se le hace exámenes complementarios y se llega a un diagnóstico de divertículo faringo-esofágico o Zenker. Esta patología no es muy frecuente, pero se presenta en ancianos por una alteración anatomo-funcional que es un debilitamiento del músculo esofágico Hay tres divertículos esofágicos de los cuales el divertículo de Zenker es el más común aunque es relativamente raro que se presente, en la mayoría de las personas en edad seniles. Después de analizar el tamaño y forma del divertículo de este paciente se toma la decisión de una intervención quirúrgica el más acertado por el tamaño que mide es la diverticulectomia este tratamiento quirúrgico actualmente se continúa realizando en esta patología y con buen pronóstico de vida del paciente. Actualmente, el paciente se encuentra en buen estado salud y su recuperación es favorable desde la operación hasta el momento.

A case of a male patient of 66 years old was referred to our hospital (COSSMIL), after making an anamnesis in which the patient manifested cough, regurgitation and bad breath (halitosis). After further examination a the diagnosis is pharyngo-esophageal diverticulum or Zenker. This condition is rare, but sometimes it happens in elders due to an anatomical and functional alteration caused by is an esophagus muscle weakening. There are three esophageal diverticula in which the Zenker diverticulum is the most common but relatively rarely to occur in elder people. Before analyzing the size and shape of the diverticulum in this patient, the decision is proceed with surgery, the most recommended solution for measuring the size of the diverticulectomy. is The surgical treatment is still being applied in this pathology, with a high probability of success. Currently, the patient is in good health and the recovery from surgery is favorable so far.

First National Consensus on the Safe Practice of Medical Tourism for Bariatric Surgery in Mexico.

BACKGROUND: Medical tourism is increasing every year, especially in fields such as bariatric surgery. Global concerns rely on the fact of its safety, mainly because of a lack of standardization, unknown number of cases, and the type of specialists performing such procedures. Mexico continues to be among the top countries receiving patients from abroad, but there is no national consensus, guidelines, or recommendations about the practice in such fields. METHODS: A group of 32 bariatric surgeons with an accumulated experience of 25,196 procedures in the medical tourism modality were gathered to perform a national consensus in bariatric surgery tourism. The Delphi methodology was used for this project, with a total of 52 items applied. A consensus was reached when the experts' position was ≥ 70% for each statement. The items included pre- and postoperative phases, patient selection, follow-up, and ethical and legal considerations. RESULTS: Of the 52 statements, 40 (76.9%) reached a consensus of ≥ 70%; 36 in favor, 5 against, and 11 with indeterminate responses. CONCLUSIONS: Although more than two-thirds of the statements related to high standard practice reached a consensus, weak points in the medical tourism modality were identified. This first consensus serves to establish the basis of safe practices, eventually reach national guidelines, and define the top standards of care when performing bariatric surgery tourism.

Hepatitis autoinmune en pediatría, una revisión del Grupo de Trabajo de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (LASPGHAN) / Autoimmune hepatitis in pediatrics, a review by the Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

La hepatitis autoinmunitaria es una enfermedad inflamatoria crónica del hígado caracterizada por una interacción compleja entre factores genéticos, respuesta inmunitaria a antígenos presentes en los hepatocitos y alteraciones de la regulación inmunitaria. Presenta una distribución global, con predominio en individuos de sexo femenino. Se clasifica en dos grupos, según el tipo de autoanticuerpos séricos detectados. La forma de presentación más frecuente es la hepatitis aguda (40 %), con síntomas inespecíficos, elevación de aminotransferasas e hipergammaglobulinemia. El tratamiento estándar consiste en la administración de fármacos inmunosupresores. Es una patología compleja, a veces difícil de diagnosticar. Si no se trata de manera adecuada, la mortalidad puede alcanzar el 75 % a los 5 años de evolución.

Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver characterized by a complex interaction among genetic factors, immune response to antigens present in hepatocytes, and immune regulation alterations. Its distribution is global and there is a female predominance. AIH is divided into 2 groups, depending on the type of serum autoantibodies detected. The most common presentation is acute hepatitis (40%), with nonspecific symptoms, high aminotransferase levels, and hypergammaglobulinemia. Standard treatment consists of the administration of immunosuppressive drugs. It is a complex condition, often difficult to diagnose. If not managed adequately, the 5-year mortality rate may reach 75%.

Autoimmune hepatitis in pediatrics, a review by the Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. / Hepatitis autoinmune en pediatría, una revisión del Grupo de Trabajo de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (LASPGHAN).

Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver characterized by a complex interaction among genetic factors, immune response to antigens present in hepatocytes, and immune regulation alterations. Its distribution is global and there is a female predominance. AIH is divided into 2 groups, depending on the type of serum autoantibodies detected. The most common presentation is acute hepatitis (40%), with non-specific symptoms, high aminotransferase levels, and hypergammaglobulinemia. Standard treatment consists of the administration of immunosuppressive drugs. It is a complex condition, often difficult to diagnose. If not managed adequately, the 5-year mortality rate may reach 75%.

La hepatitis autoinmunitaria es una enfermedad inflamatoria crónica del hígado caracterizada por una interacción compleja entre factores genéticos, respuesta inmunitaria a antígenos presentes en los hepatocitos y alteraciones de la regulación inmunitaria. Presenta una distribución global, con predominio en individuos de sexo femenino. Se clasifica en dos grupos, según el tipo de autoanticuerpos séricos detectados. La forma de presentación más frecuente es la hepatitis aguda (40 %), con síntomas inespecíficos, elevación de aminotransferasas e hipergammaglobulinemia. El tratamiento estándar consiste en la administración de fármacos inmunosupresores. Es una patología compleja, a veces difícil de diagnosticar. Si no se trata de manera adecuada, la mortalidad puede alcanzar el 75 % a los 5 años de evolución.

Conocimientos, actitudes y prácticas sobre la COVID-19 en adultos de la República Dominicana / Knowledge, attitudes and practices regarding COVID-19 in adults from the Dominican Republic

Introducción: Con la aparición del nuevo miembro de la familia coronavirus, SARS-CoV-2, la humanidad inició una batalla contra una enfermedad hasta el momento desconocida, la COVID-19. Objetivo: Determinar los conocimientos, actitudes y prácticas sobre la COVID-19 al inicio del estado de emergencia en la población adulta dominicana. Métodos: Se realizó un estudio de corte transversal, entre el 3 y el 17 de abril de 2020. El instrumento de recolección fue un cuestionario en línea con 4 secciones; características sociodemográficas, conocimientos, actitudes y prácticas sobre la COVID-19. La muestra estuvo integrada por 1861 participantes. Resultados: El 45,7 por ciento de los integrantes conocía que en ausencia de fiebre un infectado puede transmitir el virus a otro, 27,7 por ciento consideró suficiente la información circulante en la población dominicana, 32,2 por ciento confiaba que el gobierno dominicano controlaría la pandemia, 91,7 por ciento usaba mascarillas en multitudes. Conclusiones: Los resultados revelan un alto nivel de conocimiento, actitudes optimistas y prácticas adecuadas sobre la COVID-19 durante el brote inicial de la enfermedad en el país. República Dominicana enfrenta un gran desafío para controlar la transmisión del virus, pero a diferencia de otros países, una proporción significativa de los participantes no confían en las capacidades de las instituciones gubernamentales para su control. Aunque se deben realizar otros estudios a nivel comunitario en niveles socioeconómicos más bajos(AU)

Introduction: With the appearance of a new member in the coronavirus family, SARS-CoV-2, humanity started a battle against a hitherto unknown disease, COVID-19. Objective: To determine the knowledge, attitudes and practices concerning COVID-19 at the beginning of the emergency in the Dominican adult population. Methods: A cross-sectional study was conducted between April 3 and 17, 2020. The data collection instrument was an online questionnaire with four sections: sociodemographic characteristics, knowledge, attitudes and practices concerning COVID-19. The sample consisted of 1861 participants. Results: 45.7 percent of the members knew that, in the absence of fever, an infected person can transmit the virus to another person. 27.7 percent considered the information circulating in the Dominican population as sufficient. 32.2 percent trusted that the Dominican government would control the pandemic. 91.7 percent wore face masks in crowded places. Conclusions: The results reveal a high level of knowledge, optimistic attitudes and appropriate practices concerning COVID-19 during the initial outbreak of the disease in the country. The Dominican Republic faces a great challenge to control the transmission of the virus; but, unlike other countries, a significant proportion of the participants do not trust the capacities of government institutions to control it. However, other studies should be carried out at the community or at lower socioeconomic levels(AU)

Bariatric surgery in Mexico: training, practice and surgical trends.

Bariatric surgery is extremely safe and effective, but several factors need to be addressed to obtain such results. Patient selection, type of training, accreditation, type of practice, and surgical trends and technique are involved in this process. Local and global standardization are ill-advised, especially in countries with high obesity prevalence, and where the bariatric practice is fast growing.An online survey with 22 questions was sent to bariatric surgeons in Mexico. Only participants with the active practice were included, and the aim was to obtain for the first time insight in bariatric surgery training, characteristics of current practice and surgical trends.Complete responses from 114 surgeons were obtained. Most were male, under 50 years-old, ≤ 10 years of experience, and practice in low-volume hospitals. Less than half had a 12-month formal training. Gastric bypass and sleeve gastrectomy were the most common procedures. Practice trends like leak tests, use of drains, preoperative weight loss, routine endoscopy, and pharmacological tromboprofilaxis are common. In surgical technique, the gastric bypass and sleeve gastrectomy confection was more homogenic when compared to the one-anastomosis gastric bypass.Complete responses from 114 surgeons were obtained. Most were male, under 50 years-old, ≤ 10 years of experience, and practice in low-volume hospitals. Less than half had a 12-month formal training. Gastric bypass and sleeve gastrectomy were the most common procedures. Practice trends like leak tests, use of drains, preoperative weight loss, routine endoscopy, and pharmacological tromboprofilaxis are common. In surgical technique, the gastric bypass and sleeve gastrectomy confection was more homogenic when compared to the one-anastomosis gastric bypass. An important number of bariatric surgeons in Mexico are young, male, and with < 10 years of practice. The most common techniques performed are gastric bypass and sleeve gastrectomy. Several practices and technique trends are similar to global consensus. Fellowship programs and Board Certification in bariatric surgery are major advances in our country, thus standardization and high-quality practice can be achieved.

Evaluation of the In-Vitro Dissolution Permeation Systems 1 (IDAS1) as a potential tool to monitor for unexpected changes in generic medicaments in poorly regulated markets.

Panama, like most Latin American countries, has insufficient regulatory safeguards to ensure the safety and efficacy of all pharmaceutical products in the market, a situation that results in a two-tier system, where affluent citizens can afford innovator products while poor citizens must consume 'generics' of uncertain quality. Given that one lot of each drug product is analyzed every five years during registration while commercial lots are not, and since most products are not bioequivalent but simply copies or similars, there is a concern that commercial and registration lots of these 'generics' may not be of the same quality. The objective of this study was to assess the ability of various in vitro quality control tests to detect difference among five amlodipine products available in the Panamanian market: four 'generics', made in various countries, and the innovator, made in Germany and used as reference listed drug in Panama (Pan-RLD). The innovator manufactured in the United States (US-RLD) was used to compare the two RLDs. The Content Uniformity test, 30-min Dissolution test and multiple-pH Dissolution Profiles did not show any difference among the products. However, the in vitro dissolution absorption system 1 (IDAS1) showed a statistically significant difference in the amount dissolved between Pan-RLD and three out of the four 'generics', and significantly lower permeated amount for all the 'generics' compared with Pan-RLD; only US-RLD was similar to Pan-RLD. Thus, IDAS1 showed promise as a potential tool that authorities in weakly regulated markets can use to monitor for possible lot-to-lot product changes, which can help improve the quality of pharmaceutical products available to their entire populations. The significance of the similarity between the innovators made in Germany and the United States and their difference from the 'generics' (manufactured in other countries) is not known but deserves investigation.

Relación de intencionalidad en pacientes con intoxicaciones agudas por plaguicidas en un hospital de Ibagué-Colombia / Acute pesticide poisoning and its relationship with intentionality in patients from a hospital in Ibague-Colombia

Resumen Introducción: La intoxicación aguda por plaguicidas, asociada al suicidio, es un problema de salud pública cuyo estudio es primordial por los organismos estatales. Objetivo: Establecer la relación de intencionalidad en pacientes con intoxicación aguda por plaguicidas, junto a la descripción de algunas características sociodemográficas y de exposición registrados en un hospital de Ibagué desde 2013 a 2016. Materiales y métodos: Se realizó un estudio observacional descriptivo de corte transversal retrospectivo en 137 registros notificados con intoxicación aguda por plaguicida según los códigos del CIE 10. Desarrollo de análisis estadístico descriptivo y estratificado para encontrar la asociación de características con la intencionalidad de la intoxicación. Resultados: El 50% de los casos correspondían a personas menores de 20 años; el 79,6% de las intoxicaciones tenían fines suicidas y se observó que el 45% realizaron un intento de suicidio previo; un nivel educativo alto correspondió a un bajo riesgo de envenenamiento intencional [OR=0,05; IC95% (0,01-0,56); p=0,01]. Conclusiones: Es necesaria la cooperación entre las autoridades en salud e instituciones públicas para implementar medidas de control y demás estrategias que prevengan las intoxicaciones con plaguicidas, particularmente la exposición voluntaria asociada al suicidio, fenómeno creciente en esta ciudad.

Abstract Introduction: Acute pesticide poisoning associated with suicide is a public health problem that requires special attention by state agencies. Objective: To establish the relationship of patient's intent with acute pesticide poisoning and describe some sociodemographic and exposure characteristics registered by a hospital in Ibagué (Colombia), from 2013 to 2016. Materials and methods: A retrospective, cross-sectional, descriptive, observational study was conducted on 137 reports of acute pesticide poisoning that were registered according to ICD 10 codes. A descriptive and stratified statistical analysis was applied to establish the association between characteristics of poisoning intentionality. Results: 50% of the cases corresponded to people who were under 20 years of age. 79.6% of the poisonings were due to suicide attempt and 45% had had a previous attempt. A high educational level corresponded to a lower risk of intentional poisoning [OR=0.05; IC95% (0.01-0.56); p=0.01]. Conclusions: Cooperation between health care authorities and public institutions is necessary to implement measures and strategies in order to prevent acute pesticide poisoning events, especially those associated with suicide attempts, the frequency of which is growing in this city.

COVID-19: IFSO LAC Recommendations for the Resumption of Elective Bariatric Surgery.

BACKGROUND: COVID-19 pandemic varies greatly and has different dynamics in every country, city, and hospital in Latin America. Obesity increases the risk of SARS-CoV-2 infection, and it is one of the independent risk factors for the most severe cases of COVID-19. Currently, the most effective treatment against obesity available is bariatric and metabolic surgery (BMS), which further resolves or improves other independent risk factors like diabetes and hypertension. OBJECTIVE: Provide recommendations for the resumption of elective BMS during COVID-19 pandemic. METHOD: This document was created by the IFSO-LAC Executive Board and a task force. Based on data collected from a survey distributed to all IFSO-LAC members that obtained 540 responses, current evidence available, and consensus reached by other scientific societies. RESULTS: The resumption of elective BMS must be a priority maybe similar to oncological surgery, when hospitals reach phase I or II, treating obesity patients in a NON-COVID area, avoiding inadvertent intrahospital contagion from healthcare provider, patients, and relatives. Same BMS indication and types of procedures as before the pandemic. Discard the presence of SARS-CoV-2 within 72 h prior to surgery. Continues laparoscopic approach. The entire team use N95 mask. Minimum hospital stays. Implement remote visits for the follow-up. CONCLUSION: Resumption of elective BMS is crucial because it is not only a weight loss operation but also resolves or improves comorbidities and appears to be an immune restorative procedure of obese patients in the medium term, offering them the same probability of contracting COVID-19 as the regular population.

Emisiones de dióxido de carbono en estratos de mangle en la Amazonia Oriental Brasileña / Carbon dioxide emissions in mangrove strata of the Eastern Brazilian Amazonia

Introducción: Las emisiones de dióxido de carbono de los suelos de manglar tienen un impacto potencial en el balance global de carbono. Objetivo: Investigar la estacionalidad de las emisiones de dióxido de carbono relacionadas con diferentes estratos de la vegetación de manglar, así como las variables físico-químicas del suelo y las ambientales. Métodos: Se demarcaron nueve parcelas de 20 x 20 m (tres para cada estrato de vegetación). Las emisiones de dióxido de carbono fueron monitoreadas durante 88 días a través de la metodología de respiración basal del suelo. Resultados: Los resultados mostraron que las mayores emisiones de dióxido de carbono se presentaron en la temporada lluviosa 2017 con 21.8 (7.3 ± 3.3) mg/100 cm3 y 15.7 (5.2 ± 1.6) mg/100 cm3 en el período menos lluvioso. En análisis de componentes principales con un 56 % de varianza total, demostró que las mayores correlaciones de las emisiones de dióxido de carbono y las variables físico-químicas se dieron en el estrato adulto; la humedad del suelo, pH, materia orgánica, carbono y nitrógeno microbiano fueron las variables más correlacionadas. La prueba Kruskal-Wallis corroboró estos resultados comprobando diferencias significativas entre los estratos de vegetación y las emisiones de CO2 (P= 0.0170), y la prueba de Tukey confirmó mayor importancia estadística del manglar adulto en relación con los otros estratos (P= 0.0140). Conclusión: En las tres estaciones analizadas, las mayores emisiones acontecieron en el periodo lluvioso con promedio de 14.5 TCO2 ha/año y el estrato adulto fue el responsable de las mayores emisiones, registrando 21 TCO2 ha/año diferencia que fue estadísticamente significativa con los otros estratos (P = 0.0140).

Introduction: Carbon dioxide emissions from mangrove soils have a potential impact on the global carbon balance. They are related to anthropic actions and natural processes with interspecific interactions involving physical-chemical and environmental variables. Objective: In this research, the seasonality of carbon dioxide emissions related to different strata of mangrove vegetation, soil physical-chemical makeup and physical environmental factors were evaluated. Methods: Nine plots of 20 x 20 m were demarcated (three for each of the three vegetation strata) in the Experimental Site of the Federal Rural University of the Amazon and the Federal University of Pará in Cuiarana, Salinópolis, Pará, Brazil. Duplicate soil samples were taken from each plot during three consecutive seasonal periods and analyzed in the laboratory. Carbon dioxide emissions were monitored for 88 days through the basal breathing of the soil methodology; other variables evaluated were soil moisture and temperature, hydrogenic potential, redox potential,carbon and nitrogen of the microbial biomass, organic matter and composition of sand, silt and clay. Precipitation data was obtained from the CMORPH technique of the Climate Forecast Center - NOAA. Information on tides was obtained from the Brazilian Navy's Fundeadouro de Salinópolis. Results: The results showed that the highest carbon dioxide emissions occurred in the rainy season 2017 on average 7.5 (14.5 TCO2 ha/year) mg/100 cm3. With 10.5 mg/100 cm3 (21 TCO2 ha/year), the adult stratum was the largest source of emissions. The highest seasonal correlations of the emissions in relation to the incubation intervals occurred in the rainy season, in the adult stratum the days 1,2,3,4,3,3 and 5. Using principal component analysis (PCA) it was found that the highest correlations of carbon dioxide emissions and physical-chemical variables occurred in the adult stratum with 56 % variance. The highest correlations were found with the variables soil moisture, Ph, organic matter, carbon and microbial nitrogen. The Kruskal-Wallis test corroborated these results, indicating significant differences between vegetation strata and CO2 emissions (P= 0.0170); and the Tukey test confirmed greater statistical importance of the adult mangrove in relation to the other strata (P= 0.0140). Conclusions: In the three analyzed stations, the highest emissions occurred in the rainy period with an average of 14.5 TCO2 ha/year and the adult stratum was responsible for the highest emissions registering 21 TCO2 ha/year difference that was statistically significant with the other strata (P = 0.0140).

Social media, advertising, and internet use among general and bariatric surgeons.

INTRODUCTION: The use of the internet and technology has increased, and its implication with medicine is inevitable. Along with these technologies, social media platforms have changed the interaction between peers, forcing an evolution on medical activities and patient relationship. There is no clear information on how surgeons interact with these platforms within their daily practice. METHODS: A transverse study with a survey obtained from general and bariatric surgeons from Mexico was performed, aimed to gather information about social media platforms use (Facebook, Instagram, Twitter, and LinkedIn). Personal, professional, academic, and marketing activities were analyzed and compared between general and bariatric surgeons. Secondly, the same analysis was performed in younger participants. Other variables were also analyzed, such as type of marketing and monthly budget. RESULTS: We obtained 523 surveys (84.1% general and 15.8% bariatric surgeons), where male gender comprised 86.4%. Almost a third considered social media as an important tool. In 53% of the cases, Facebook was preferred for professional activities; Twitter was the second most used. Bariatric surgeons were younger, used all platforms more frequently, and preferred Facebook for every activity. They also invested more in publicity, and showed wider marketing methods than general surgeons. CONCLUSION: There is an important awareness of internet and social media use among general and bariatric surgeons. Facebook leads the activities for both specialties (personal, professional, academic, and marketing), but bariatric surgeons are significantly more involved; additionally, there are more marketing strategies and investment among them.

In vitro toxicity assessment of zinc and nickel ferrite nanoparticles in human erythrocytes and peripheral blood mononuclear cell.

Ferrite nanoparticles (NPs) have gained attention in biomedicine due to their many potential applications, such as targeted drug delivery, their use as contrast agents for magnetic resonance imaging and oncological treatments. The information about the risk effects of ferrite NPs in human blood cells is, however, scarce. To assess their potential toxicity, in vitro studies were carried out with magnetite and zinc, nickel and nickel­zinc ferrites NPs at different concentrations (50, 100 and 200 µg·ml-1). The toxicity of the ferrite NPs was evaluated in humans by determining red blood hemolysis, by measuring the content of total proteins, and by assaying catalase and glutathione-S-transferase activities. Our results show that nickel­zinc ferrite lead to hemolysis, and that magnetite, zinc and nickel­zinc ferrites increase glutathione-S-transferase activity. No significant changes in human peripheral blood mononuclear cells viability were observed after the treatment with the four different ferrite NPs in vitro.

Prevalencia de hipertensión arterial en adolescentes del preuniversitario "Salvador Allende" / Prevalence of hypertension in adolescents of "Salvador Allende" senior high school

Se realizó un estudio analítico, de corte transversal, desde octubre 2012 hasta febrero de 2013, de 829 escolares de décimo y onceno grados, que cursaban estudios en el Preuniversitario "Salvador Allende" del municipio de Boyeros en La Habana, con vistas a determinar la prevalencia de hipertensión arterial y su asociación con algunos factores de riesgo. Se encontró que la prevalencia general de prehipertensos fue de 3,8 y la de hipertensos de 5,9 por cada 100 estudiantes; asimismo, existió una asociación entre esta y el índice de masa corporal. Finalmente, dicha prevalencia estuvo entre el rango permisible en investigaciones internacionales y fue evidente que esta enfermedad era desconocida por más de 90 % de los afectados.

An analytic cross-sectional study, was carried out from October, 2012 to February, 2013 in 829 scholars of tenth, and eleventh grades who studied in "Salvador Allende" senior high school in Boyeros, Havana city, aimed at determining the prevalence of hypertension and its association with some risk factors. It was found that the general prevalence of prehypertensive students was 3.8 and that of hypertensive students of 5.9 every 100 students; also, there was an association between this prevalence and body mass index. Finally, this prevalence was in the permissible range in international investigations and it was evident that this disease was unknown for more than 90% of the affected students.

Falla de medro / Failure to thrive

Presentamos el caso clínico de un paciente atendido en el hospital del Niño Dr. Ovidio Aliaga Uría, que corresponde a una falla de medro como causa de desnutrición secundaria. Aprovechamos el tema para hacer una revisión del mismo.

We present a clinical case of patient seen at Childrens' Hospital "Ovidio Aliaga Uria", suffering from failure to thrive due to a secondary malnutrition. We decided to revise the subject.

Enfermedad celiaca con presentación atípica / Atipical celiac disease

Presentamos tres casos clínicos de pacientes que fueron internados en el Hospital del Niño "Dr. Ovidio Aliaga Uría" por enfermedad celiaca con manifestaciones clínicas de presentación infrecuentes.

We describe three cases of atypical clinical presentation of celiac disease who were admitted to the Hospital del Niño "Dr. Ovidio Aliaga Uría".

Constipación crónica, a propósito de dos casos / Chronic constipation, a case report

Presentamos dos casos clínicos de pacientes atendidos en el hospital del Niño Dr. Ovidio Aliaga Uría, que corresponden a una constipación crónica de causa orgánica debidas a una hipoganglionosis y enfermedad de Hirschsprung. Aprovechamos el tema para hacer una revisión del mismo.

We present two clinical cases of patients seen at Childrens’Hospital “Ovidio Aliaga Uria”, suffering from organic chronic constipation due to a hypoganglionosis and Hirschsprung’s disease. We decided to revise the subject.

Bolsa de Indiana en el tratamiento de tumores malignos de la pelvis y de sus secuelas: experiencia de 20 años en el Instituto Nacional de Cancerología / Indiana pouch for the treatment of pelvic tumors and their aftermaths: a 20-year experience at the National Cancer Institute

Objetivo: Valorar la función renal y los efectos colaterales de la bolsa de Indiana como método quirúrgico. Método: Reporte de serie de casos de 75 pacientes operados desde junio de 1987 hasta junio del 2008 con bolsa de Indiana. Resultados: Los tumores incluyeron 36 cánceres de vejiga, 35 cánceres de útero, 2 melanomas vaginales, 1 cáncer de vulva y 1 osteoclastoma, La bolsa se usó en 35 cistectomías radicales y 14 exenteraciones pélvicas, y en 26 pacientes se hizo sin cirugía extirpativa tumoral. El 95% de pacientes mantuvo la función renal. Los electrolitos séricos permanecieron normales. La continencia completa se consiguió en 92% de los casos. La capacidad promedio del reservorio fue de 536,5 ml; 21 (25,8%) riñones sanos se perdieron al reimplantarse. Por otra parte, 22 (56,4%) riñones hidronefróticos llegaron a ser sanos. Complicaciones: temprana, 6,66%; tardía 46,0%. Reintervención: temprana, 8,0%; tardía 40,1%. Mortalidad perioperatoria 8,0%; mortalidad acumulativa, 45,30%. Supervivencia promedio: 30,7 meses. Conclusiones: La bolsa de Indiana es una derivación urinaria útil cuando no es factible preservar la uretra. Presenta más complicaciones tardías que tempranas. La hidronefrosis, el daño parenquimatoso y la neocistolitiasis fueron frecuentes en esta serie, con 48% de pacientes irradiados.

Objective: To evaluate the renal function and side effects of the Indiana pouch at the National Cancer Institute of Colombia. Method: 75 cases with history of Indiana Pouch reconstructive surgery were recruited from June 1987 to June, 2008. Results: 36 bladder; 35 uterine cancer; 1 vulvar cancer, vaginal cancer, 2 melanomas; and 1 osteoclastoma were included. The Indiana Pouch was used in 35 radical cystectomies, and 14 pelvic exenterations. In 26 cases, there was non-surgical tumor extirpation. 95% of patients continued with proper renal function and normal serum electrolytes. Complete continence was present in 92% of cases. The average reservoir capacity was 536.5ml; 22 (24.7%) healthy kidneys were lost after re-implantation. In contrast, 22 (56.4%) hydro-nephronic kidneys became healthy. Early complications were present in 6.66% of cases; and late complications in 46.70%. Early re-intervention was observed in 8.0%; late, 40.1%. Perioperative mortality was 8.0%; cumulative mortality, 45.3%. The average survival was 30.7 months. Conclusions: The Indiana Pouch is a useful urinary device when urethra preservation is not possible. Complications occur late rather than early. Hydronephrosis, parenchymatic damage and neo-cystolytiasis were frequent in this series, wherein 48% of patients were irradiated.

Educación medica continua: vacuna frente a rotavirus / Continuing medical education: a vaccine against rotavirus

La diarrea de origen viral corresponde aproximadamente al 40 por ciento de todos los casos de diarrea infantil infecciosa en paises en desarrollo.