Experience in colorectal surgery at a quaternary care hospital in Bogotá, Colombia.

INTRODUCTION AND AIMS: Colorectal cancer is among the three most common cancers worldwide. Knowledge and identification of suboptimal outcome-associated factors enable comprehensive patient management. The aim of the present study was to present the results of the surgical management of colorectal cancer at a quaternary care university hospital. MATERIALS AND METHODS: An observational, analytic, cross-sectional study was conducted. Information was collected on a retrospective cohort of patients diagnosed with colorectal cancer from 2013 to 2017 at the Hospital Universitario Mayor Méderi, Bogotá, Colombia. RESULTS: Data on 452 patients, within the study period, were collected. A total of 48.5% of the patients were men, the overall complication rate was 24%, the surgical site infection (SSI) rate was 15.38%, anastomotic dehiscence occurred in 4.18% of the patients, bleeding required reoperation in 1.32%, and the intrahospital mortality rate was 7.47%. CONCLUSION: Colorectal cancer management at a university hospital was as beneficial as that provided by other types of hospitals, showing a direct association with complete R0 dissections; low complication rates, according to international reports; and reduced overall morbidity.

Giant retroperitoneal liposarcoma surgical management.

Retroperitoneal liposarcomas are very infrequent retroperitoneal malignant tumours. Most patients complain of palpable abdominal mass and only half present with abdominal pain. With haematogenous spread they can reach, mainly, lungs and liver, but only in 10% of cases. Here we report the presentation and surgical treatment of a giant massive retroperitoneal liposarcoma in a 53-year-old man.

Giant retroperitoneal liposarcoma surgical management.

Retroperitoneal liposarcomas are very infrequent retroperitoneal malignant tumours. Most patients complain of palpable abdominal mass and only half present with abdominal pain. With haematogenous spread they can reach, mainly, lungs and liver, but only in 10% of cases. Here we report the presentation and surgical treatment of a giant massive retroperitoneal liposarcoma in a 53-year-old man.

Thoracoscopic management of congenital esophageal stenosis secondary to tracheobronchial remnant in pediatric patients. / Manejo toracoscópico en estenosis esofágica congénita secundaria a remanente traqueobronquial, en población pediátrica.

INTRODUCTION: Congenital esophageal stenosis (CES) is an extremely rare pathology in children, with an incidence of 1/25,000-50,000 live births. According to its histopathological classification, there are three types of CES: fibromuscular hyperplasia, membranous diaphragm, and tracheobronchial remnants. CLINICAL CASE: We present the clinical case of a 39-month-old male patient diagnosed with CES secondary to tracheobronchial remnants, with multiple vomit and reflux episodes since he was 4 months old. He was admitted at the emergency department with respiratory distress. An upper GI endoscopy and an esophagogram were initially carried out. Stenosis resection and thoracoscopic esophageal anastomosis were performed. CONCLUSIONS: Tracheobronchial remnants are the second most common presentation of congenital esophageal stenosis. They can be managed through dilatations or surgery according to etiology.

INTRODUCCION: La estenosis congénita de esófago es una patología extremadamente rara en niños, con una incidencia de 1/25.000-50.000 nacimientos. Según la clasificación histopatológica se encuentran tres tipos: hiperplasia fibromuscular, diafragma membranoso y remanentes traqueobronquiales. CASO CLINICO: Se presenta un caso clínico de un paciente masculino de 39 meses con diagnóstico de estenosis congénita del esófago secundario a remanentes traqueobronquiales, que presentó múltiples episodios de vómito y reflujo desde los 4 meses del nacimiento. Ingresó en el Servicio de Urgencias por presentar signos de dificultad respiratoria, realizándosele estudios iniciales de endoscopia de vías digestivas altas y esofagograma. Se practicó resección de estenosis y anastomosis esofágica toracoscópica. CONCLUSIONES: Los remanentes traqueobronquiales son la segunda causa de presentación de la estenosis esofágica congénita. El manejo de esta patología puede ser de dos formas, ya sea por medio de dilataciones o quirúrgico, y la elección de una u otra va a depender de su etiología.

Early presentation of post-intubation tracheoesophageal fistula with severe tracheal stenosis in COVID-19 patient.

The current global COVID-19 pandemic is caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, acquired tracheoesophageal fistulas are mainly iatrogenic lesions produced by prolonged tracheal intubation. We present a case of tracheoesophageal fistula with severe tracheal stenosis following tracheal intubation in a patient with SARS-CoV-2 infection.

Multidisciplinary management of giant cervicothoracic cutaneous squamous cell carcinoma.

INTRODUCTION: Cutaneus squamous cell carcinoma (SCC) is the second most common type of nonmelanoma skin cancer. SCC is a malignant neoplasm of the skin characterized by aberrant proliferation of keratinocytes. PRESENTATION CASE: We report multidisciplinary surgical management of a 36-year-old male who presented with a huge cutaneous protruding tumor of the cervicothoracic wall. Clinically, he presented with a growing mass on the anterior cervicothoracic wall 3 years ago. Microscopic examination revealed SCC. He underwent complete excision of the lesion. The patient neglected attending our oncological department for receiving chemotherapy. Today, one year after surgery, he is alive without evidence of disease recurrence. DISCUSSION: SCC treatment depends on location of the lesion, involvement of neighboring structures, functional level of the patient, and the patient's acceptance of the proposed management strategy. CONCLUSION: We conclude that SCC can grow to a huge size if left untreated. Surgery by a multidisciplinary surgical team is the primary mode of treatment, followed by chemotherapy if necessary.

Preventative laparoscopic repair of Petersen's space following gastric bypass surgery reduces the incidence of Petersen's hernia: a comparative study.

INTRODUCTION: Internal hernias (IH) are late complications of bariatric surgery, specifically gastric bypass and manifest with diffuse abdominal pain and/or intestinal obstruction. They have a low incidence, however, are increasingly common in patients undergoing laparoscopic gastric bypass (LGBP). Petersen's internal hernia is one of the most frequent internal hernias following Bariatric surgery. METHODS: We describe our experience at a third-level surgical center using a prophylactic Petersen's space herniorrhaphy immediately following LGBP as a preventative strategy for post-bariatric internal hernias. In addition, we perform a retrospective descriptive study with 667 patients undergoing LGBP under which we divided into two groups. In the first group, the Petersen's space was not closed, and in the second group, the Petersen´s space closure was performed using non-absorbable polypropylene non-interrupted sutures. RESULTS AND CONCLUSIONS: 667 patients were taken to LGBP, and of which 5 presented internal hernias. From the 346 patients who had Petersen´s herniorrhaphy performed, one developed signs of an internal hernia at 22 months follow-up and was subsequently confirmed later with laparoscopy (0.02%). Of the 321 patients not having had Petersen's space closure, 4 developed Petersen's internal hernia at an average of 22-month post-op, incidence of 0.1%. We analyzed and compared our results with those reported in the literature. Petersen's space closure immediately after a LGBP with an alimentary loop in the anterior colic position (prophylactic herniorrhaphy) with non-interrupted non-absorbable suture is a useful, safe, and effective technique to prevent the development of Petersen's IH during the post-operative period following LGBP.

[Complex febrile Seizures or Dravet syndrome?: Description of 3 case reports]. / ¿Crisis febriles complejas o síndrome de Dravet?: Descripción de 3 casos clínicos.

INTRODUCTION: Dravet syndrome (DS) is one of the most intractable forms of epilepsy that begins in infancy. This syndrome is characterized by beginning with complex febrile seizures (FS) in a healthy infant and progresses to refractory epilepsy with psychomotor regression. The detection of a SCN1A mutation encoding the sodium channel can confirm the diagnosis. OBJECTIVE: To report 3 confirmed cases of genetically DS. CASE REPORTS: We describe 3 girls diagnosed with complex FS that started when they were between 2 and 7 months old. FS were frequent, hemi generalized and myoclonic associated with recurrent febrile status epilepticus (SE). Despite FS and SE recurrence, the psychomotor development, electrophysiological studies and magnetic resonance imaging (MRI) of the brain were normal. After a year, they developed afebrile seizures progressing to refractory epilepsy with developmental regression. A molecular study detected SCN1A mutation confirming DS. The specific antiepileptic treatment and prevention of febrile episodes allowed partial control of epilepsy with some recovery of psychomotor skills. CONCLUSIONS: The high frequency complex FS associated with recurrent SE in a previously healthy infant should alert about the possibility of DS. Molecular diagnostics helps us to establish a drugs and non-drug therapies treatment, as well as long-term prognosis and genetic counseling.

Baseline plasmaccholinesterase activities in argentine saddle horses from sabana deboogotá / Activdad colinessterasa plasmática en caballos silla Argentina de la sabana de bogotá

The determination of cholinesterase (ChE) activity in domestic animals is of great importance for diagnosis and research purposes. The present work was aimed to determine the baseline plasma ChE activities (acetylcholinesterase, AChE and butyrylcholinestarase, BChE) of Argentine saddle horses sampled from equine farms of Bogota (Colombia) and its surroundings. Plasma AChE and BChE catalytic activities were measured in 60 healthy horses by spectrophotometry within the visible spectrum (405 nm). AChE mean ± SD values (nmols/ml/min) for males (n=32) were 1566 ± 301. Age intervals results were, 0.5-5 years: 1526 ± 295, 6-10 years: 1532 ± 313, 11-15 years: 1615 ± 279, and > 15 years: 1617 ± 335. As for females (n=28), mean AChE was 1323 ± 432, with age intervals as follows, 0.5-5 years: 719 ± 108, 6-10 years: 1603 ± 313, 11-15 years: 1225 ± 294, > 15 years: 1519 ± 369. BChE in males were 3304 ± 822; with age intervals, 0.5-5 years: 3383 ± 715, 6-10 years: 3360 ± 766, 11-15 years: 3267 ± 1064, > 15 years: 3206 ± 861. As for females, BChE values were 3097 ± 432, with age intervals: 0.5-5 years: 2467 ± 981, 6-10 years: 3668 ± 750, 11-15 years: 3238 ± 979, and > 15 years: 3015 ± 925. AChE was significantly different between males and females (t test, p < 0.05) and for both genders when age groups were compared (ANOVA, p < 0.05). BChE had higher values than AChE for both genders and yet no significant difference was found when genders were compared. No differences were found in BChE for age groups in both genders. In a second test, 15 random samples, kept at 4 ºC for 72 hours, were analyzed for variations when measured every 24h. Neither AChE nor BChE had significant variations in these 24h-apart measurements. The present investigation found baseline activities for the two types of plasma cholinesterases in Argentinian saddle horses. This will allow researchers and clinicians to count on reference values for diagnosis and comparative purposes.

La determinación de la actividad colinesterasa (ChE) en animales domésticos es de importancia en diagnóstico e investigación. El presente trabajo tuvo como objetivo principal la determinación de la línea base de actividad ChE plasmática (acetilcolinesterasa, AChE y butirilcolinesterasa, BChE) en 60 caballos Silla Argentino muestreados en fincas de equinos ubicadas en Bogotá (Colombia) y sus alrededores. Las actividades catalíticas de AChE y BChE plasmáticas fueron medidas mediante espectrofotometría visible (405 nm). Los valores promedio ± desviación estándar de actividad AChE (nmols/ml/ min) para machos (n=32) fueron 1566 ± 301. En intervalos de edad, los resultados fueron, 0.5-5 años: 1526 ± 295, 6-10 años: 1532 ± 313, 11-15 años: 1615 ± 279, y > 15 años: 1617 ± 335. En hembras (n=28), la actividad AChE fue 1323 ± 432, con valores en intervalos de edad, 0.5-5 años: 719 ± 108, 6-10 años: 1603 ± 313, 11-15 años: 1225 ± 294, > 15 años: 1519 ± 369. La BChE en machos fue 3304 ± 822; con intervalos de edad, 0.5-5 años: 3383 ± 715, 6-10 años: 3360 ± 766, 11-15 años: 3267 ± 1064, > 15 años: 3206 ± 861. En hembras, la BChE fue 3097 ± 432, con intervalos de edad: 0.5-5 años: 2467 ± 981, 6-10 años: 3668 ± 750, 11-15 años: 3238 ± 979, y > 15 años: 3015 ± 925. La actividad AChE fue significativamente diferente entre machos y hembras (test t, p < 0.05) y en ambos géneros al comparar los grupos etáreos (ANAVA, p < 0.05). BChE tuvo valores más altos que AChE, sin embargo, no en forma significativa cuando se compararon los resultados entre los dos géneros, ni cuando se compararon los grupos etáreos en los dos géneros. En una prueba adicional, 15 muestras fueron tomadas al azar y mantenidas a 4ºC durante 72 horas para ser analizadas cada 24 horas; AChE y BChE no mostraron variaciones significativas entre las mediciones hechas en este período de tiempo. El presente estudio permitió determinar lineas base de los dos tipos de colinesterasas plasmáticas en caballos tipo silla Argentino con el propósito de ofrecer valores de referencia con fines diagnósticos y comparativos para clínicos e investigadores.

Intubación con paciente despierto con fibroscopio retromolar de Bonfils bajo sedación con dexmedotomidina. Reporte de 7 casos / Awake insertion of the Bonfils retromolar intubation fiberscope

Diversas guías de manejo y algoritmos para el manejo y control de la vía aérea difícil recomiendan la intubación con el paciente despierto, como un método seguro. En los últimos años la intubación en paciente despierto se ha realizado con fibroscopio flexible o mediante laringoscopia clásica y directa . Últimamente se han desarrollado múltiples dispositivos ; entre dichos estiletes se destaca el fibroscopio retromolar de Bonfils; este es un instrumento óptico semi-rígido en una curva anterior de 40 grados. Al acomodarlo dentro de un tubo endotraqueal y pasarlo por la vía aérea superior, es posible dirigirlo bajo visión directa a la glotis. Se presentan en esta serie 7, casos de intubación en pacientes con vía aérea complicada, bajo sedación con dexmedetomidina con fibroscopia retromolar de Bonfils, sin aplicación de anestesia tópica.

Acording to the “Practice Guidelines for management of a difficult airway”, and several algorithnes, an awake intubation is considered the first method to secure a suspected difficult airway. During last years the awake intubation was performed by flexible fiberoptic laringoscopy or with a rigid stylet. Within the last decade, many new devices have been developed to assist anesthesiologist with both routine and difficult airway management, one of wich is the Bonfils Retromolar Intubacion Fiberscope. It is a semi-rigid optical stylet 40 cm. long of 5,0 external diameter and a tip curvature of 40 degrees; the adult stylet can accommodate a 6,5 mm. endotracheal tube and sliding it in the superior airway, it is possible to entubate the glottis under direct vision. We present seven case report with difficult airway, managed with dexmedotomidine using the Bonfils retromolar fiberscope without topical anesthetic.

Vanadium pentoxide inhalation provokes germinal center hyperplasia and suppressed humoral immune responses.

Vanadium, an important air pollutant derived from fuel product combustion, aggravates respiratory diseases and impairs cardiovascular function. In contrast, its effects on immune response are conflicting. The aim of our work was to determine if spleens of vanadium-exposed CD1 mice showed histological lesions that might result in immune response malfunction. One hundred and twelve CD-1 male mice were placed in an acrylic box and inhaled 0.02 M vanadium pentoxide (V2O5); actual concentration in chamber approximately 1.4 mg V2O5/m(3)) for 1 hr/d, twice a week, for 12 wk. Control mice inhaled only vehicle. Eight mice were sacrificed prior to the exposures. Eight control and eight V2O5-exposed mice were sacrificed 24 hr after the second exposure of each week until the 12-wk study was over. Another 8 mice that completed the 12-wk regimen were immunized with recombinant Hepatitis B surface antigen (HBsAg; three times over an 8-wk period) before sacrifice and analyses of their levels of anti-HBsAg antibody (HBSAb) using ELISA. In all studies, at sacrifice, blood samples were obtained by direct heart puncture and the spleen was removed, weighed and processed for H-E staining and quantitation of CD19 cells. The results indicated that the spleen weight of V2O5-exposed animals peaked at 9 wk (546 +/- 45 vs. 274 +/- 27 mg, p < 0.0001) and thereafter progressively decreased (321 +/- 39 mg at 12 wk, p < 0.001; control spleen = 298 +/- 35 mg). Spleens of V2O5-exposed animals showed an increased number of very large and non-clearly delimited germinal centers (that contained more lymphocytes and megakaryocytes) compared to those of control mice. In addition, their red pulp was poorly delimited and had an increase in CD19+ cells within hyperplasic germinal nodes. The mean HBsAb levels in immunized control mice were greater than that in the exposed hosts (i.e., OD = 0.39 +/- 0.03 vs. 0.11 +/- 0.05, p < 0.01). HBsAb avidity dropped to a value of 40 in V2O5-exposed animals vs. 86 in controls (p < 0.0001). We conclude that the chronic inhalation of V2O5, a frequent particle (PM(2.5)) component, induces histological changes and functional damage to the spleen, each of which appear to result in severe effects on the humoral immune response.

Programa de dotación de equipo médico-hospitalario para los establecimientos de salud / Es

La información y criterios básicos, los recurso humanos, físicos y tecnológicos conforman el marco general para la formulación del programa de dotación de equipos médico-hospitalario para los establecimientos de salud del proyecto BO-OO56