Revista Med

rev.fac.med

ISSN 1909-7700

www.umng.edu.co
Bogotá D.C., Colombia

INDEX

CONTENTS

PRESENTATION

EDITORIAL

SIMPLIFIED GAMMAGRAPHIC METHOD FOR THE STUDY OF PEDIATRIC PATIENTS WITH CHRONIC IDIOPATHIC CONSTIPATION

MARGARITA MARTÍNEZ V. M.D., CIRUJANA PEDIATRA1; LUIS CARLOS RINCÓN L., M.D., CIRUJANO PEDIATRA. 2,3* Y FÉLIX ACOSTA M.D., INTERNISTA, ESPECIALISTA EN MEDICINA NUCLEAR4.

1Residente del Programa de Cirugía Pediátrica de la Universidad Militar Nueva Granada; 2Servicio de Cirugía Pediátrica del Hospital Militar Central; 3Profesor de Cirugía Pediátrica de la Facultad de Medicina de la Universidad Militar Nueva Granada; 4Servicio de Medicina Nuclear del Hospital Militar Central

Abstract

It is estimated that constipation is a common problem in children, accounting on the average as much as 25% of pediatric consultations. It has become a true challenge for the pediatric surgeon because no specific organic cause can be found in approximately 90% of the cases. Our study had two main objectives. First, to demonstrate the ability to replicate the method widely described in the literature and to simplify the gammagraphic exam described for the assessment of pediatric patients with chronic idiopathic constipation, and also to justify its use and value to provide enough information for the effective treatment of this pathology. This paper demonstrates that the gammagraphic colonic transit time is a viable and precise method for assessment of patients with chronic idiopathic constipation. The advantages of gammagraphic studies against other types, which use radio-opaque markers, are evident. It is a well-tolerated method, non-invasive and furthermore provides minimal radioactive exposure.

Key words: constipation, gastrointestinal transit, Hirschsprung disease

Archivo PDF

STUDY OF THE EFFECTIVENES OF FOUR DIFFERENT DESIGNS OF INTRALUMINAL STENTS IN ENTERIC DRAINAGE AND DECOMPRESSION

ANDREA TRÓCHEZ R., M.D. 1*, LUIS CARLOS RINCÓN L., M.D., CIRUJANO PEDIATRA. 2,3 Y RAFAEL ORTÍZ, INGENIERO CIVIL 4

1Residente del Programa de Cirugía Pediátrica de la Universidad Militar Nueva Granada; 2Jefe del Servicio de Cirugía Pediátrica del Hospital Militar Central; 3Profesor de Cirugía Pediátrica de la Facultad de Medicina de la Universidad Militar Nueva Granada; 4Departamento de Ingeniería Civil de la Universidad Nacional de Colombia.

Abstract

Multiple surgical pediatric intestinal diseases are a real challenge for the medical team, because they compromise seriously the intestines limiting the treatment options and with it the survival options. For that reason the creativity of the surgeon in the surgical field is the resource to find an alternative that give us hope. It is like this how enteric drain stents were designed, modifying existing elements, as a solution to protect the compromised gut, help its recovery, drain its contents and stop its isquemic deterioration. Additionally they limit the formation of obstructive adhesions and the need for wide resections. The present work intends to raise its use and find common elements for the design of an ideal catheter, with optimal biophysical qualities related to the diseases to treat. With these objectives we did a hydraulic simulation of the most used drains which may serve as an excellent starting point in the design of a new product. The conclusion is that the ideal stent is not yet developed and more research like this is necessary for an optimal result, using the main characteristics of actual drains: smooth surface of PVC, softness of the silicon and the technology of the Blake’s® drain in the search for a for larger surface for maximum drainage.

Archivo PDF

TEMPORAL DINAMIC PROBABILITIES OF THE MALARY EPIDEMIC IN COLOMBIA

JAVIER RODRÍGUEZ V., M.D.1*

1Director Grupo Insight y de la Línea de Investigación Teorías Físicas y Matemáticas Aplicadas a la Medicina. Universidad Militar Nueva Granada

Abstract

The malaria epidemic has been studied from space-time mathematical models searching for causal relationships to predict their development, such as climate, geographical location, population movements, among others. Based on the calculation of probabilities, the temporal dynamics of malaria in Colombia since 1960 were characterized. For this purpose a total space of probabilities was built that quantifies the annual appearance of infected cases in ranges of 5,000 and 10,000 , and the mean square deviation for sets of ranges was assessed, comparing the behavior of the probabilities for these sets. Finally, the number of infected cases in 2007 was predicted with the associated value to the corresponding ranges for the last three consecutive years. According to the prediction, the number of malaria cases in 2007 would have been between 106,000 and 116,000 with the assessment of the ranges of 10,000, and between 108,000 and 113,000, with ranges of 5,000. These values were compared with the report from the National Institute of Health of the 52o epidemiological week of 2007, which registered 108,848 infected, obtaining a 100% accurate prediction of the phenomenon with both ranges. The evaluation of the dynamics of the epidemic based on the definition of ranges, and the probabilistic study of registered values respect to them, allows to predict the annual number of infected cases of malaria in Colombia, in a causal and simple way, with a methodology easy to implement which also saves resources.

Archivo PDF

INCIDENCE OF PNEUMONIA ASSOCIATED WITH MECHANIC VENTILATION IN PATIENTS WITH TRAUMA ADMITTED TO THE INTENSIVE CARE UNIT AT THE HOSPITAL MILITAR CENTRAL

ANDREA P. VILLAMIL C., M.D. 1*, ANESTESIÓLOGA, ADRIANA VARGAS D. M.D. 1*, ANESTESIÓLOGA Y HENRY OLIVEROS R., M.D., ANESTESIÓLOGO, MAGISTER EN EPIDEMIOLOGÍA CLÍNICA 1,2

1Estudiante del Programa Medicina Crítica y Cuidados Intensivos, Universidad Militar Nueva Granada. 2* Jefe Unidad de Educación e Investigación, Hospital Militar Central, Profesor de Medicina Crítica y Cuidado Intensivo, Universidad Militar Nueva Granada.

Abstract

Pneumonia associated to mechanic ventilation causes 15-20% of the nosocomial infections and produces most of the secondary deaths associated to them. It is estimated that there is an accumulated frequency of this pathology between 2,4 and 14,7 cases for 1.000 days of ventilation in different types of ICU; however there is no data in our setting about the incidence of this type of pneumonia in the patients with trauma. The objective of this work was to determine the incidence of pneumonia associated to mechanic ventilation in the critically traumatized patients, its impact in the morbidity-mortality and the responsible microorganisms. We identified 304 trauma patients admitted to the surgical ICU of the Hospital Military Central requiring mechanical ventilation in the period between January 2001 and August 2008. The incidence of pneumonia associated to mechanic ventilation for every 1000 days of ventilation mechanics was found to be 10 patients, the general risk of pneumonia was 7.8%, the highest risk was after day 16 of mechanic ventilation in 34%. The pneumonia associated to mechanic ventilation was an independent mortality risk factor (OR 2,7). In early-onset pneumonia, the most common pathogen was Pseudomonas aeruginosa in 40% of the cases, and in late-onset polymicrobial pneumonia, the two main isolated organisms were: Staphylococcus aureus in 66% and Pseudomonas aeruginosa in 34%. It was concluded that the rate of pneumonia in the trauma patients is similar in value to patients with other pathologies; however it was found that pneumonia associated to mechanic ventilation is an independent mortality risk factor, increases the hospital stay and the need for invasive supportive ventilation in this type of patient.

Archivo PDF

BIOCOMPATIBILITY EVALUATION OF CARBONATED APATITE OF DRY SYNTHESIS THROUGH PORCINE OSTEOPROGENITORS CULTURE

CONSTANZA CARRETERO, BIÓLOGA1, CLAUDIA BERNAL, BACTERIÓLOGA, MARTHA LUCÍA TORRES, MICROBIÓLOGA, M.SC. 1, K. JAMUNA THEVI, CIENCIA DE MATERIALES, M.SC. 2, FADZIL AYAD ZAKARIA, CIENCIA DE MATERIALES, PH.D. 2 Y JOSÉ MIKÁN, BIÓLOGO, PH.D. 1*

1 Grupo Biotecnología en Salud, Laboratorio de Investigaciones, Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia. 2 Biomaterials Programme, Advanced Materials Research Centre (AMREC), SIRIM Berhad, Lot 34, Jalan Hi-Tech 2/3, Kulim Hi-Tech Park, 09000 Kulim, Kedah, Malaysia.

Abstract

The development of new materials for bone regeneration constitutes a challenge for biomedical sciences, especially when it is desirable to design synthetic materials that simulate the most the composition of natural bone. In this work biocompatibility of carbonated apatite (CAp) was evaluated. CAp was prepared through mechano-chemical mixing, compression and sintered at high temperature (referred as dry synthesis) of powdered precursors. This ceramic was then used as a substrate for the culture of porcine osteogeprogenitors. Cells were obtained from the bone marrow of adult porcine just after sacrifice by series of dilutions. Cells were then cultured onto culture plates or onto CAp, with and without addition of known differentiation osteogenic factors. Cultures were carried out for 45 days during which the doubling time of the culture was determined as well as the osteoconductivty of CAp, by means of determining some biochemical and molecular markers. A primary culture of porcine bone marrow osteoprogenitor was established and was used for the in vitro evaluation of a ceramic material synthetised by solid state reaction. The potential use of the material as a substitute for natural bone implant was explored, by analysing its osteoconductive capacity, through light and electron microscopy and expression of biochemical and molecular markers, such as the expression of alkaline phosphatase, calcium deposition and xylenol orange accumulation, concomitant with detection of Runx2, osteocalcin and osteopontin.

Archivo PDF

TREATMENT OF ACUTE GOUT

DANIEL G. FERNÁNDEZ A., M.D.1*, JOHN LONDOÑO P., M.D.2,3, PEDRO SANTOS M., M.D.2, ELSA REYES S., M.D.2 Y RAFAEL VALLE O., M.D.2.

1Residente del Programa de Reumatología, Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá. 2Reumatólogo, Servicio de Reumatología Hospital Militar Central, Bogotá. 3Reumatólogo, Profesor Asociado Universidad de La Sabana, Bogotá.

Abstract

Gout has been amply described from the times of Galen and it continues to be a public health problem hat causes important morbidity in the world population. The treatment of acute gout has not changed in the last years, but a current review and actualization of the medical literature is necessary since there are continuous flaws in the management of this illness, not only in the actual indication of specific drugs, but also in the attentive care required due to the potential development of side effects from the traditional medications used in the treatment.

Archivo PDF

NUCLEAR REPROGRAMMING AND INDUCED PLURIPOTENT CELLS

ORLANDO CHAPARRO, PH.D.1* Y ORIETTA BELTRÁN, MD, M.SC.2

1 Profesor asociado Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. 2Profesora asistente Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia.

Abstract

Reprogramming of somatic cells to generate induced pluripotent stem cells (iPS), has been one of the most important advances in biology in recent years. The identification of a group of transcription factors and more recently of some chemical compounds that can induce pluripotency in somatic cells provides a unique opportunity to study cellular and molecular mechanisms of cell differentiation and promises the possibility of generating patient-specific pluripotent stem cells for the treatment of multiple diseases in protocols of cell therapy and regenerative medicine.

Key words: nuclear reprogramming, pluripotency, reprogramming factors, Induced pluripotent Stem Cells (iPS).

Archivo PDF

LAPAROSCOPIC EVALUATION OF CONTRALATERAL INGUINAL HERNIA IN CHILDREN. ¿IS THERE A JUSTIFICATION TO EXPLORE IT?

ANA MARÍA CASTILLO F. M.D.1*, LUIS CARLOS RINCÓN L. M.D.2 Y JUAN PABLO LUENGAS M.D.3

1Cirujana Pediatra, Universidad Militar Nueva Granada, Hospital Militar Central. 2Cirujano Pediatra, Universidad Militar Nueva Granada, Jefe Servicio Cirugía Pediátrica, Hospital Militar Central. 3Cirujano Pediatra, Universidad Militar Nueva Granada, Hospital Militar Central

Abstract

The high incidence of a contralateral patent processus vaginalis has led to the development of new laparoscopic techniques which have revived the controversy around the contralateral exploration. With this project we evaluate the usefulness of laparoscopy in the diagnosis of contralateral inguinal hernia. It was performed in children between 0 and 15 years in the pediatric surgery service of the Central Military Hospital in the period between May 2005 and August 2008, through an observational,analytical, prospective cohort study. The study allowed us to determine through laparoscopy, which patients had contralateral inguinal hernia, making the correction in the same surgical time, avoiding the possibility of a complicated metachronous contralateral hernia, a new anesthetic risk and the cost of a second hospitalization; similarly these results were confonted with global statistics.

Archivo PDF

PULMONARY TOXOPLASMOSIS IN AN IMMUNOCOMPETENT PATIENT. CASE REPORT AND LITERATURE REVIEW

CAROLINA SÁNCHEZ, M.D. 1, JAMES M. YURGAKY, M.D, 2 Y FRANCISCO RODRÍGUEZ, M.D., INTERNISTA DIABETÓLOGO3

1Residente del Programa de Medicina Interna de la Universidad Militar Nueva Granada, Bogotá, D.C., Colombia 2Residente del Programa de Medicina Interna de la Universidad Militar Nueva Granada, Bogotá, D.C., Colombia; 3 Servicio de Medicina Interna, Hospital Militar Central Bogotá, D.C., Colombia

Abstract

This work describes the case of a 26 years old adult, previously healthy, referred to the Hospital Militar Central with a clinical picture of an acute febrile syndrome and generalized adenomegaly, who was diagnosed with a Toxoplasma gondii infection by the detection of specific immunoglobulins, with evidence of pulmonary and lymph node compromise, which resolved with medical treatment with trimetoprim sulfametoxazol.

Archivo PDF

PRIMARY INTRAOSSEOUS SQUAMOUS CELL CARCINOMA OF THE MANDIBLE. CASE REPORT

LUZ ADRIANA SABOGAL G., ODONTÓLOGA, CIRUJANA ORAL Y MAXILOFACIAL1*, ALEJANDRA ROJAS, ODONTÓLOGA, CIRUJANA ORAL Y MAXILOFACIAL1 Y JOSÉ ANTONIO VÉLEZ S, ODONTÓLOGO 2

1Servicio de Cirugía Oral y Maxilofacial, Hospital Militar Central, Bogotá, Colombia, 2Residente del Programa de Cirugía Oral y Maxilofacial, Universidad Militar Nueva Granada, Bogotá, Colombia

Abstract

The primary intraosseous squamous cell carcinoma of the mandible is classified by the World Health Organization within the odontogenic carcinomas. It is a rare disease. Epidemiologically the male:female ratio is 3,5:1. The highest incidence is in the fifth and sixth decades of life. The most affected area is the posteroinferior mandibular region. It is a locally aggressive tumor that metastasizes to regional lymph nodes. The clinical diagnosis is difficult, because their behavior is intraosseous so it can last long periods of time before the diagnosis is made. It requires a pathological study which detects the presence of intraoseus carcinomatous epithelial cells. Imaging shows a radiolucent lesion with osteolysis in the form of atypical cystic lesions poorly defined in most cases. The treatment of choice for curative purposes is to provide an excision with wide safety margins and subsequent reconstructive surgery. We present a 31 years old patient with a primary mandibular intraosseous squamous cell carcinoma (solid type), whose treatment consisted of an en bloc resection and right mandibular reconstructive surgeries to obtain an adequate functional and aesthetic result.

Archivo PDF

FRANTZ’ TUMOR: CASES REPORT

ANDREA TRÓCHEZ R., M.D. 1*, RAFAEL R. PEÑA, M.D., CIRUJANO PEDIATRA. 2 Y MARTÍN GÓMEZ T. M.D., CIRUJANO PEDIATRA 2,3

1Residente del programa de Cirugía Pediátrica de la Universidad Militar Nueva Granada. 2Servicio de Cirugía Pediátrica del Hospital Militar Central, 3Profesor de Cirugía Pediátrica de la Facultad de Medicina de la Universidad Militar Nueva Granada.

Abstract

Frantz pancreatic tumors are an infrequent pathology, histogenesis remain controversial, they occur predominantly in young women and because of their low-grade malignant potential, complete resection means good survival. The aim of this review is to present a retrospective analysis of two cases, which, because of their diagnostic difficulties can teach a lot in the evaluation process of this pathology and of its importance in the abdominal tumors differential diagnosis in children, which, when well managed with the adequate surgical method, allows the patients an excellent recovery and prognosis.

Archivo PDF

FRONTAL-ORBITAL-NASAL RECONSTRUCTION WITH PSI IMPLANTS. REPORT OF A CASE

CAMILO A. ESLAVA J., ODONTÓLOGO, CIRUJANO ORAL Y MAXILOFACIAL1 Y ALEIDA NEIRA H., ODONTÓLOGA2*

1Servicio de Cirugía Oral y Maxilofacial, Hospital Militar Central, Bogotá, D.C., Colombia; 2Residente del Programa de Cirugía Oral y Maxilofacial, Universidad Militar Nueva Granada, Bogotá, D.C. Colombia

Abstract

The reconstruction of the craniofacial complex has been an important challenge in the field of reconstructive surgery and for years there has been a diversity of materials used. The results, as with other bony craniofacial reconstructions, depend on the surgical abilities, the quality of the adjacent soft tissues, the size and localization of the osseous defect and the selected reconstructive method. We present the case of a soldier who suffered a firearm wound and who had a craniofacial reconstruction using polyether-ether-ketones (PEEK), a material available for medical use since 1998.

Archivo PDF

MEDICINE AND WAR: THE SLOW EXTENSION OF MILITARY MEDICINE IN COLOMBIA

HUGO ARMANDO SOTOMAYOR TRIBÍN, M.D, PEDIATRA, MSC EN SEGURIDAD Y DEFENSA NACIONALES*

Profesor de la Facultad de Medicina de la Universidad Militar Nueva Granada y de la Fundación Universitaria de Ciencias de la Salud

Abstract

Archivo PDF

RECOMMENDATIONS TO THE AUTHORS