Central Military Hospital Research Articles

Clinical-Oncological Characteristics And Global Survival Of Patients With Testicular Tumor Of Germinal Cells Registered In The Central Military Hospital "CRL Luis Arias Schreiber" In The Period From 2004 To 2014

Objective: To identify clinical oncological characteristics and overall survival in patients with seminoma and non-seminoma germ cell testicular tumor. Methods: Retrospective study in patients with seminoma and non-seminoma germ cell testicular tumors, attended at the Central Military Hospital CRL LUIS ARIAS SCHREIBER, from January 2004 to January 2014. Study variables: tumor markers, stage and treatment. Finally, global survival was realized. Results: During the study period from January 2004 to January 2014, a total of 26 patients were registered with histopathological diagnosis of germ cell tumor between seminomas and nonseminomas. Histopathologically, the most frequent type was germ cell tumor was non-seminoma type (69.23%), 33% of its variants were mixed tumor type, followed by pure choriocarcinoma with 28%, pure embryonic carcinoma 17% , 11% yolk sac and 11% pure teratoma. Seminoma-type germ cell tumors (30.77%)Within its variants, 62.5% of these were classic seminomas and 37.5% of multinodular seminoma.During the observation period of 179 months with an average of 106 months and a median of 101 months theOverall survival rate at 5 years was 92.3%. (p <0.05). Conclusion: The present study showed a good prognosis. Survival is attributed substantially to accurate diagnosis and effective treatment. With regard to the management of this neoplasia, testicular tumor of germ cell seminomas and non-seminomas must be multidisciplinary.   DOI 10.25176/RFMH.v18.n4.1726

Manejo endovascular de fístula arteriovenosa postraumática

Objectives: To report a case of chronic arteriovenous fistula as a late complication of a gunshot wound, which was managed with a covered stent placement in the femoral artery. Design: Images and records were taken from the Central Military Hospital to report the clinical case. In the following article, we describe the experience of the Central Military Hospital in the treatment of a chronic arteriovenous fistula with en endovascular management.

New approach method in minimally invasive surgery for rectal cancer: transanal endoscopic surgery

Abstract Introduction: Apply and assess the early results of Transanal Total Mesorectal Excision (TaTME) for mid and low rectal cancer. Material and Methods: A prospective study in 45 patients (31 men and 14 women) suffering from mid and low rectal cancer, undergoing TaTME in Department of Gastrointestinal Surgery, 108 Military Central Hospital, from July 2017 to August 2018. Results: Pre-operative stages were mrT2: 8.9%, mrT3: 66.7%, mrT4a: 11.1%; mrTx: 13.3%. mrN (+): 73.3%, mrN(-): 20%, mrNx: 6.7%. The mean age was 64.56 ± 10.97 years, the mean body mass index was 20.5 ± 2.5 kg/m2. Low rectal cancer was 60% and mid rectal cancer was 40%. The mean operative duration was 145.33 ± 22.47 minutes. Operative morbidity rate was 33.3%, no operative mortality was detected. The macroscopic quality assessment of the resected specimen was complete in 77.8% nearly complete in 17.8%, the distal resection margin negative rate was 100% and the circumferential resection margin negative rate was 88.9%; The mean number of harvested lymph nodes was 4.52 ± 3.74. Postoperative stages were pT0: 6.7%, pT1: 2.2%, pT2: 31.1%, pT3: 53.3%, pT4a: 6.7%; pN-: 68.9%, pN+: 31.1%. Kirwan classification in anorectal function after 6 to 9 months of the operation was: Kirwan I and Kirwan II: 81.2%. Conclusion: TaTME technique was feasible and safe with the good early outcomes, the high-quality of TME specimens and sphincter-sparing resections for treatment in mid and low rectal cancer.

The Results of liver resection with intraoperative ultrasound for hepatocellular carcinoma in Vietnam

Aim: To evaluate the value of intraoperative ultrasound and early results of liver resection for hepatocellular carcinoma. Materials and method: Uncontrolled study enrolled 30 patients underwent liver resection for hepatocellular carcinoma with intraoperative ultrasound in Viet Duc university hospital and central military hospital 108. Results: There were 26 male, and 4 female with average age of 49,4 ± 11,2 (26-68 years old). The chronic HBV infection rate is 96,7%, AFP level more than 400 ng/ml found in 36,7% of patients. Major hepatectomy rate was 30%, minor hepatectomy rate was 70%. Intraoperative ultrasound detected new tumors in 10% cases, and changed the operative plans in 20% of cases. There was no mortality, and 36,6% morbidities, in which, majority were pleural effusion. Median of hospital stay was 11 days. Conclusion: Intraoperative ultrasound is simple and feasible which help the surgeon detected new tumor in 10% of all cases and change the strategy of operation in 20% cases.

Intracompartmental Pressure Measurements in 501 Service Members with Exercise-related Leg Pain

ABSTRACT Chronic exertional compartment syndrome (CECS) is one of the recalcitrant overuse injuries of the legs. CECS is traditionally diagnosed with an intracompartmental pressure measurement (ICPM). The primary objective of this article was to report the relationship between exertional compartment pain and intracompartmental pressure in young service members. This study is a descriptive analysis of patient records from a central military hospital from 2013 to 2016 (study design: historic cohort; level of evidence, 3). A total of 573 young service members with exercise-related leg pain were evaluated. An ICPM of at least one muscular compartment was performed in 501 patients (87%) 1 min after a standardized running test. CECS (32%), medial tibial stress syndrome (MTSS) + CECS (27%), and MTSS (21%) were the most common diagnoses. In the CECS category, most patients (68%) had ICPM values >35 mm Hg in both anterior and deep posterior compartments, 22% had isolated CECS of the anterior compartments, and the others had combinations of pressures >35 mm Hg in one or more of the four leg compartments (9%). Comparison of exertional pain scores with the ICPM showed a negligible correlation for the anterior compartments (Spearman rank correlation coefficient = 0.257, confidence interval = 0.191–0.327). Service members rated needle pain of the ICPM procedure as moderate: median pain rating 5 out of 10 (range 1–10). This score did not significantly differ between men and women (P = 0.409) and was not different if only anterior compartment versus multiple compartments were measured (P = 0.236). There is a negligible correlation between exertional compartment pain level and intracompartmental pressure in the leg. Current advice to avoid or minimize ICPM due to needle pain concerns does not appear warranted.

LEVIT Vladimir Semenovich –
 doktor meditsinskikh nauk, professor, zasluzhennyy deyatel' nauki RSFSR, vydayushchiysya khirurg, dekan meditsinskogo fakul'teta Irkutskogo universiteta, general-mayor meditsinskoy sluzhby

Vladimir Semyonovich Levit was born in 1883 and after graduation from the gymnasium he studied at the Medical Faculty of the University of Koenigsberg (1901-1906), worked in the Ardatov Zemstvo of the Simbirsk Gubernia. In 1914, Vladimir Semenovich defended his doctoral dissertation, became head of the surgical department of the Simbirsk Province Hospital, and began teaching at a paramedic school. V.S. Levit was elected privat-docent of the faculty surgical clinic of Tomsk University (1919), privat-docent (1922), then professor and head of the department of the faculty surgical clinic, dean of the medical faculty (1922-1926) of Irkutsk University, head of the department of hospital surgery of medical faculty. 2 Moscow University (since 1926), which is headed for 27 years. V.S. Levit for the first time in the USSR successfully resected cardia (1928), surgery for hernia of the esophageal aperture (1929). In 1936 he was awarded the title of Honored Scientist of the RSFSR. During the Great Patriotic War V.S. Levit was appointed chief surgeon of the Moscow Military District, deputy chief surgeon of the Soviet Army (1942), and in 1943 he became a major general of the medical service. Since 1950, V.S. Levit - chief surgeon of the Central Military Hospital. P.V. Mandrika. He published 120 scientific works, he was the editor of 3-volume manual, 2-volume textbook on surgery, the surgical section of the Great Medical Encyclopedia, the publication "The Experience of Soviet Medicine in the Great Patriotic War of 1941-1945." V.S. Levit was the editor of the magazine "Soviet Surgery" (later "Surgery") (1931-1953), a member of the editorial board of the journals "New Surgery", "Russian Clinic", "Central Medical Journal." He was the head and scientific consultant in the preparation of 23 candidate and 10 doctoral dissertations. V.S. Levit was a member of the International Surgical Society, chairman of the Moscow Surgical Society, a member of the Academic Council of the Ministry of Health of the USSR, and district Soviets of Working People's Deputies. V.S. Leviticus was awarded the Order of the Red Banner, the Patriotic War of the 2nd degree, the Red Star, medals. V.S. Leviticus died in 1961 in Moscow.

Frecuencia relativa de ocurrencia de casos probables de «despertar intraoperatorio» (DIO) en pacientes sometidos a anestesia general balanceada en el Hospital Central Militar

Introduction: Intraoperative awareness (IA) is a rare phenomenon that affects approximately 0.1-0.2% of patients undergoing general anesthesia balanced (GBA). Material and methods: Observational, descriptive and transversal study to detect probable cases of IA in subjects who were undergoing GBA in the Central Military Hospital. The statistical method used was the relative frequency of occurrence. Results: We included a sample of 105 patients to whom we applied the questionnaire of Brice in the immediate postoperative period and 24 hours after their surgical procedure. In a six-month study period, were studied 105 individuals who met the inclusion criteria for the study, 51% (54/105) were female and 49% (51/105) men. Laparoscopic cholecystectomy (29%) was the most common intervention. We applied the questionnaire of Brice in the immediate postoperative period to all individuals included in the study (100%; 105/105). Three probable cases of IA were detected, representing 2.8% of the universe of study. Conclusions: The questionnaire of Brice was a tool that was easy to use, inexpensive, viable, and free of negative clinical organizational impact to detect probable cases of IA in the institution.

SPINE SURGERY

Introduction: low back pain is basic medical issue in our general population,it influence our day by day life exercises and bargains our personal satisfaction. Intervertebraldisc herniation is one of the commonest reasons for backache and sciatica. Discectomy isthe essential treatment of decision for disc herniation. Objective: To determine the incidenceand indication of revision spine surgery after lumber discectomy. Study Design: Retrospectivestudy. Setting: Spine Surgery Unit of Central Military Hospital Rawalpindi. Period: Ten yearsfrom July 2007 to August 2017. Methods: Patients who presented with disc herniation for whichdiscectomy was done were included into this retrospective study. Patient’s statistic profile,indications, signs and imaging finding were recorded. Discectomy was performed throughone-sided Fenestration at symptomatic side. Post-operative patient’s changes was notedand recorded. Three hundred and fifty two patients were contemplated amid most recent tenyears. Results: out of 352 patients, 214 were male 138 were female patients; age ranged from20 to 70 years. 74(21.02 %) patients out of 352 again presented with severe backache andsciatica, recurrent disc herniation was confirmed on MRI lumbosacral. 46 (62.16%) out of 74patients were complaining of backache than sciatica, backache more severe on activity andrelieved on rest. 28(37.83%) out of 74 patients had sciatica than backache. TLIF was done in46 patients and remaining 28 patients treated with laminectomy and discectomy. Back painand sciatica was relieved in all patients (100%) after TLIF and discectomy and quality of lifeimproved. Conclusion: Our study concluded that incidence of spine surgery revision is 21%and indication of surgery is either stability or recurrence of disc herniation. TLIF is having goodresult in patient with stability issue and discectomy in patients’ with sciatica than backache.

REVISION OF SPINE SURGERY AFTER SIMPLE LUMBER DISCECTOMY

Introduction: low back pain is basic medical issue in our general population,it influence our day by day life exercises and bargains our personal satisfaction. Intervertebraldisc herniation is one of the commonest reasons for backache and sciatica. Discectomy isthe essential treatment of decision for disc herniation. Objective: To determine the incidenceand indication of revision spine surgery after lumber discectomy. Study Design: Retrospectivestudy. Setting: Spine Surgery Unit of Central Military Hospital Rawalpindi. Period: Ten yearsfrom July 2007 to August 2017. Methods: Patients who presented with disc herniation for whichdiscectomy was done were included into this retrospective study. Patient’s statistic profile,indications, signs and imaging finding were recorded. Discectomy was performed throughone-sided Fenestration at symptomatic side. Post-operative patient’s changes was notedand recorded. Three hundred and fifty two patients were contemplated amid most recent tenyears. Results: out of 352 patients, 214 were male 138 were female patients; age ranged from20 to 70 years. 74(21.02 %) patients out of 352 again presented with severe backache andsciatica, recurrent disc herniation was confirmed on MRI lumbosacral. 46 (62.16%) out of 74patients were complaining of backache than sciatica, backache more severe on activity andrelieved on rest. 28(37.83%) out of 74 patients had sciatica than backache. TLIF was done in46 patients and remaining 28 patients treated with laminectomy and discectomy. Back painand sciatica was relieved in all patients (100%) after TLIF and discectomy and quality of lifeimproved. Conclusion: Our study concluded that incidence of spine surgery revision is 21%and indication of surgery is either stability or recurrence of disc herniation. TLIF is having goodresult in patient with stability issue and discectomy in patients’ with sciatica than backache.

Translation and cultural validation of clinical observational scales – the Fugl-Meyer assessment for post stroke sensorimotor function in Colombian Spanish

Purpose: Fugl-Meyer Assessment (FMA) is the most widely used and recommended clinical scale for evaluation of sensorimotor impairment post stroke, but an official Spanish version is not available today. This study aimed to establish methodological structure for translation and cultural adaptation process and perform a transcultural validation of the upper and lower extremity FMA to Colombian Spanish.Methods: Procedures included forward and backward translation, step-wise reviewing by bilingual and professional experts to ensure conceptual and semantic equivalence. Validation included a pilot evaluation of item-level agreement on 10 individuals with stroke at the Central Military Hospital of Colombia.Results: Comprehensive step-wise procedure for transcultural validation was established. Low agreement (less than 70%) was detected for items assessing arm movements within synergies and for coordination/speed subscale. All points of disagreement were systematically reviewed and agreed upon when drafting the final version of the Spanish FMA.Conclusions: Use of FMA will allow unified description of stroke severity and motor recovery in Spanish speaking countries. This will open up possibility to compare stroke and rehabilitation outcomes with other countries and regions world-wide. Comprehensive methodological procedures provided can facilitate introduction of well-established clinical scales in other languages.Implications for RehabilitationThe Fugl-Meyer Assessment (FMA) of upper and lower extremity is the most used and recommended clinical scale for evaluation of sensorimotor impairment after stroke.The Spanish version of FMA, validated in this study, is now first time available for use in research and clinical practice.Use of FMA will allow unified description of stroke severity and motor recovery in Spanish speaking countries, which in turn opens up possibility to compare stroke and rehabilitation outcomes with other countries and regions world-wide.

Mejoría de la supervivencia con la intervención de un equipo multidisciplinario en el programa de implante de válvula aórtica transcatéter (TAVI)

Introduction: The implantation of the transcatheter aortic valve (TAVI) is a minimally invasive and innovative treatment with good results for patients with aortic stenosis of intermediate or high surgical risk; However, the vast majority of patients are elderly and have multiple co-morbidities that lead to increased mortality and in many cases to complications. A crucial and determining point for a good evolution is the role of the heart team of an institution, since an incomplete team or with little experience leads to a poor selection of patients. In our institution, the heart team became a multidisciplinary team composed of several specialties for the comprehensive assessment of patients. Material and Methods: A cohort of 36 patients was carried out at the Central Military Hospital from September 2013 to October 2017. Thirty-six patients with aortic stenosis and treated with TAVI were met; The fi rst 17 patients were evaluated by a cardiovascular surgeon, two interventional cardiologists, and two clinical cardiologists. Subsequently, a geriatrician, a pulmonologist, and a neurologist were included in the multidisciplinary team, among other specialties. Results: Of the 36 patients in total who were taken to TAVI, the fi rst 17 patients selected by the heart team from the beginning of the program until 2015 (47.2%) and the last 19 patients (from 2015 to date) valued by the multidisciplinary team (52.7%). In the fi rst group, they died during the follow-up at one year, 8 of 17 patients (47%) and in the second group, 2 patients of 19 (10.5%). Conclusions: The results of a program for TAVI are based on three strengths, the facilities, the training of the heart team and the experience of the valve implantation team, however, we form a multidisciplinary team composed of the heart team and another transcendental health personnel in the selection and follow-up of patients.

Standardization of impulse oscillometry and the generation of pilot equations to generate reference values in the Central Military Hospital

Introduction: Impulse oscillometry is a test that evaluates the respiratory mechanics by the application of small pulses of pressure, which produce fl ow oscillations to a certain frequency. Its main application is in the study of the illnesses of the small airline. The integrated software of the test equipment generates predictive values for each of the oscillometric parameters, based on German population data. Objective: To standardize the impulse oscillometry test in order to design pilot equations for reference values in our population. Material and methods: We performed a pilot, experimental, analytical, longitudinal study with healthy volunteer subjects. Spirometry and impulse oscillometry tests were performed, both basal impedances, resistances, and reactances of the respiratory system to and after bronchodilator application; we measured and registered the 5, 10, 15, and 20 Hz. The results were analyzed by sex, age, height, and weight. The analysis was performed using a model of multiple linear retrogression. Results: A total of 127 healthy participants were recruited, 51.5% men (68) and 48.5% (64) women, with an average age of 39.65 ± 15.26 years; their height was an average of 1.63 ± 0.09 m. It was proved that the gender infl uences the oscillometry values of tidal volume (VT), the impedance, the resistances and reactance area (p < 0.05), but not the reactances (XRs) (p > 0.05); this parameter is mainly associated with the size (r = 0.727, r2 = 0.528). The age influences the oscillometry values since the resistances (Rrs) are lower in the youngest groups; the BMI and the weight had no influence on the values of IOS. Conclusions: This study provides pilot reference equations for the common indexes of impulse oscillometry in Mexican subjects, in order to integrate this test of pulmonary function to facilitate the detection of functional alterations in the small airline. We suggest more studies should be done on Mexican population, and especially on people of advanced age, to confi rm our results and to provide a more solid base for the equations of reference to IOS, with clinical and epidemiologic purposes.

Farmacovigilancia: un paso importante en la seguridad del paciente

Although awareness of the correct use of substances used for the treatment of different diseases has the same Hippocratic principle of: «first do no harm», this was not made concrete as an ex-professed activity for the monitoring of its effects, which in recent times is called pharmacovigilance. Pharmacovigilance activities were prompted by major serious adverse reactions to drugs that were warning signs that, while they are intended to improve health status, they also have the potential to be harmful in signifi cant, even fatal, ways. Pharmacovigilance activities, as a global effort, aim to improve the safety of medicines by monitoring post-marketing adverse reactions in the open population. With the historical development of medical science, it has also become evident the need to implement mechanisms to reduce the potential for human error, as well as to identify and manage the risks and problems related to medicines; it has also been important to promote a reporting culture in order to warn of the problem, analyze its causality, and with everybody’s effort, establish mechanisms that improve the safety profile of the nations’ medication system. Mexico, as an important actor in global decision-making, has not remained isolated in the face of this scenario, and joins the efforts of the health authorities themselves in taking important steps, implementing actions that go from the regulatory sphere, and have permeated the entire health sector of our country. Faced with this hopeful scenario, it would be irresponsible to lower our guard; on the contrary, we must redouble our efforts to implement a pharmacovigilance programme. These efforts do not escape us, and that with the creation of the Hospital Pharmacovigilance Unit of the Central Military Hospital in 2014, our institution is consistent with the vision of quality and health safety.

Caracterización sociodemográfica de los pacientes que acudieron a un servicio de rehabilitación de tercer nivel de atención por lumbalgia

Objective: To identify the risk factors, demographic and laboral characteristics of the population that is treated for low back pain in the Rehabilitation Center of the Military Central Hospital. Material and methods: Retrospective, cross-sectional and descriptive study. Study variables: gender, age, weight, potential origin of the low back pain. The statistical analysis included: measures of central tendency, dispersion and standard deviation. Results: 1,952 clinical records were evaluated; 938 fulfi lled the admission criteria, 578 belonged to female patients and 360 to male ones. The most common etiologies were mechanopostural, post-surgical and post-traumatic; the number of military personnel in the active service was 276, with a greater preference for the Health Service (20.9%), Infantry (14.5%), and Air Force (11.4%). Conclusion: The female sex is more affected by low back pain. The greater number of medical assessments were done to non-military population. The mechanopostural, post-surgical and post-traumatic etiologies showed a greater frequency, mainly affecting the following services: Health Service, Infantry, and Air Force. We recommend to emphasize the factors mentioned in order to infl uence the treatment of low back pain.

Clinical utility of an optimised multiplex real-time PCR assay for the identification of pathogens causing sepsis in Vietnamese patients

IntroductionFor the identification of bacterial pathogens, blood culture is still the gold standard diagnostic method. However, several disadvantages apply to blood cultures, such as time and rather large volumes of blood sample required. We have previously established an optimised multiplex real-time PCR method in order to diagnose bloodstream infections. Material and methodsIn the present study, we evaluated the diagnostic performance of this optimised multiplex RT-PCR in blood samples collected from 110 septicaemia patients enrolled at the 108 Military Central Hospital, Hanoi, Vietnam. ResultsPositive results were obtained by blood culture, the Light Cylcler-based SeptiFast® assay and our multiplex RT-PCR in 35 (32%), 31 (28%), and 31 (28%) samples, respectively. Combined use of the three methods confirmed 50 (45.5%) positive cases of bloodstream infection, a rate significantly higher compared to the exclusive use of one of the three methods (P=0.052, 0.012 and 0.012, respectively). The sensitivity, specificity and area under the curve (AUC) of our assay were higher compared to that of the SeptiFast® assay (77.4%, 86.1% and 0.8 vs. 67.7%, 82.3% and 0.73, respectively). Combined use of blood culture and multiplex RT-PCR assay showed a superior diagnostic performance, as the sensitivity, specificity, and AUC reached 83.3%, 100%, and 0.95, respectively. The concordance between blood culture and the multiplex RT-PCR assay was highest for Klebsiella pneumonia (100%), followed by Streptococcus spp. (77.8%), Escherichia coli (66.7%), Staphylococcus spp. (50%) and Salmonella spp. (50%). In addition, the use of the newly established multiplex RT-PCR assay increased the spectrum of identifiable agents (Acintobacter baumannii, 1/32; Proteus mirabilis, 1/32). ConclusionThe combination of culture and the multiplex RT-PCR assay provided an excellent diagnostic accomplishment and significantly supported the identification of causative pathogens in clinical samples obtained from septic patients.

Manejo de pubalgia con proloterapia en el servicio de Medicina Física y Rehabilitación del Hospital Militar Central

La pubalgia es un dolor localizado en la sinfisis pubica que puede irradiarse a la ingle, el hipogastrio, la cadera e incluso el perine, y evidentemente el movimiento de las articulaciones correspondientes o el trabajo de la musculatura de estas zonas reproduciran el dolor segun la actividad. La proloterapia ayudo en la recuperacion del dolor de un paciente que se presento en el servicio de Medicina Fisica y Rehabilitacion del Hospital Militar Central. La proloterapia es la inyeccion de un agente irritante en la insercion de un tendon o en un espacio articular o en un ligamento como manejo medico complementario a otras acciones clinicas; el objetivo principal es el alivio del dolor y la reparacion de un area de lesion usando una inyeccion de una sustancia hiperosmolar. Se ha incrementado el nivel de evidencia en su utilizacion en tendinopatias refractarias como metodo seguro y ha optimizado el manejo contra el dolor de tipo musculo-esqueletico.

Identifying prognostic factors for conservative treatment outcomes in servicemen with chronic exertional compartment syndrome treated at a rehabilitation center

BackgroundChronic exertional compartment syndrome (CECS) is a condition of pain induced by exercise, and it is characterized by muscle swelling and impaired muscle function in the lower leg. Given the diversity in the diagnosis and treatment of CECS, it is desirable to determine variables pertaining to prognosis and recovery. The purpose of this study is to identify prognostic factors for conservative treatment outcomes in servicemen with CECS who were treated at a Military Rehabilitation Center.MethodsPatients from all military services were referred from the special unit for lower leg pain at the Central Military Hospital, Utrecht, the Netherlands. Descriptive analysis was used to report the characteristics of the participants and their baseline measurements. Group differences were analyzed using a Student’s t-test or Mann-Whitney U test, according to the normality of the data distribution. Differences between the pre- and post-intervention outcomes were evaluated using the Wilcoxon signed rank test. To evaluate the magnitude of prognostic factors, a univariate logistic regression analysis was performed. The prognostic factors included age, body mass index, body fat percentage, self-efficacy beliefs, foot malalignment, intramuscular pressure, other comorbidities, protein and creatine use, smoking, alcohol use, complaint duration, physical demands, and duration of military service.ResultsAfter the rehabilitation period, we observed 25 patients with a successful outcome, which was defined as a reduction in pain (≥ 2 points) during the capacity test measured using a verbal rating scale and 20 patients with an unsuccessful outcome. Factors demonstrating a limited increased odds ratio for an unsuccessful outcome included smoking, alcohol use, intramuscular pressure, a complaint duration of more than 6 months, and physical demands of service. However, these factors did not reach significance.ConclusionThis study did not identify any prognostic factors that predict the outcome of a rehabilitation program for CECS. A larger sample using an identical design might provide further evidence regarding prognostic factors, which would facilitate development of a model that predicts the outcomes of a rehabilitation program for CECS.

Incidence of intestinal obstruction due to post-surgical adhesions in the Central Military Hospital. Associated risk factors

Introduction: Intestinal obstruction (IO) due to postoperative adhesions is an important cause of hospital admissions worldwide, with signifi cant morbidity and mortality that represent great costs for health systems worldwide. Objective: To estimate the incidence of intestinal obstruction due to postoperative adhesions and to identify risk factors in patients admitted to the General Surgery Service of the Central Military Hospital (CMH). Material and methods: The database of admitted patients to the CMH was revised from January 2009 to December 2013. Of the 14,769 surgeries performed, 393 patients presented intestinal obstruction. The demographic characteristics, type and number of previous surgeries and other risk factors for adhesions were identifi ed. Each patient was classified as IO by adhesions (IOA) or as IO associated with another pathology (IOP). Results: The overall incidence of post-surgical IO was 2.7%; 236 cases (1.6%) were secondary to surgical adhesions and the rest (1.1%) were associated with other pathology. Morbidity occurred in 8.5% of the IOA patients versus 13.5% of the IOP group (p = 0.118). Mortality was 6.4 versus 12.1%, respectively (p < 0.05). Laparotomy (34%), cholecystectomy (22%) and appendectomy (19%) were the surgeries most frequently associated with obstruction. Surgical treatment was done in 20% of the patients of the IOA group, versus 43% in the IOP group (p = 0.001). Risk factors associated to IOA were: female patients, number of previous abdominal surgeries and past admissions for intestinal obstruction. Conclusions: Intestinal obstruction syndrome due to post-surgical adhesions was the most common cause of IO from 2009 to 2013 in the Central Military Hospital. The incidence of this post-surgical adhesion syndrome is similar to that reported in world literature. Therapeutic decision oriented toward an initial conservative treatment should be correct. There were fewer hospitalization days and less mortality in the adhesion group treated without surgery.

Effect of icodextrin on dry weight obtained by bioimpedance in dialysis patients

Background: Chronic kidney disease is a condition characterized by deterioration of the glomerular filtration rate coupled with inherent gastrointestinal, hematological, cardiovascular and mineral bone symptoms that condition a decrease in the quality of life of a patient. According to statistics from the United States, in 2012, Mexico, represented by the state of Jalisco, had the first place on incidence per million inhabitants and the sixth place on prevalence, below countries like Taiwan, Japan and the United States. Objective: To compare the dry weight of patients with chronic renal failure in the treatment of function by peritoneal dialysis using icodextrin with those using standard glucose solutions. Material and methods: Retrospective and observational study performed in the clinical archive service, the nephrology ward and the external dialysis consultation of the Central Military Hospital from April to September 2015. The parameters to be evaluated were dry weight, hemoglobin and albumin. The analysis was carried out using the statistical paired t method. Results: In relation to dry weight, a statistically significant difference was obtained, with a value of p < 0.05, showing that icodextrin keeps patients closer to dry weight than standard glucose solutions, translated on an average of 3.3 versus 4.2 L, icodextrin versus conventional, respectively. Conclusions: The use of icodextrin in patients with peritoneal dialysis helps to preserve the peritoneal cavity and improve the metabolic, volumetric and blood pressure control without affecting residual diuresis.

Opciones de tratamiento para la fuga paravalvular severa después de una cirugía abierta de corazón: intervencionismo por cateterismo o una segunda cirugía

The purpose of presenting this first successful case of closure of a paravalvular aortic leak with the Vascular Plug III device is to make it known that in the Central Military Hospital, treatment is another choice, besides heart surgery. Closure by percutaneous intervention is an acceptable option with good clinical results, fewer complications, fast recovery, and patients can resume their daily activities in a very short time.