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RESUMEN Aunque los desarrollos que surgen del trabajo conjunto entre ingenieros y científicos de la vida han aumentado y mejorado en las últimas décadas, todavia hay muchas cosas que hacer en esta relación. Una de ellas es la mejora urgente del sistema de salud, porque si bien la tecnologia es importante para mejorar el diagnóstico y el tratamiento, también es necesario superar los complejos problemas de cobertura, calidad, equidad y atención oportuna que sufren los pacientes en muchas partes del planeta. Los gobiernos deben tener el presupuesto adecuado para satisfacer las necesidades en salud de sus ciudadanos y fortalecer el sistema para ampliar la cobertura y mejorar su calidad. Estas son tareas pendientes que deben abordarse desde la experiencia de la ingenieria para gestionar y organizar sistemas, en un trabajo armonioso con científicos de la salud e involucrando a pacientes, médicos, gobiernos, fabricantes, otras disciplinas y la sociedad en general.

AВSTRАСT Although the developments that arise from the joint work between engineers and life scientists have increased and improved in recent decades, there are still many things to do in this relationship. One of them is the urgent improvement of the health system because although technology is important to improve diagnosis and treatment, it is also necessary to overcome the complex problems of coverage, quality, equity and timely attention that patients suffer in many parts of the planet. Governments need to have the appropriate budget to meet the health needs of their citizens and strengthen the health system to expand coverage and improve its quality These are pending tasks that must be addressed from the experience of engineering to manage and arrange systems, in harmonious work with health scientists and involving patients, doctors, governments, manufacturers, other disciplines and society in general.

RESUMO Embora os desenvolvimentos decorrentes do trabalho conjunto entre engenheiros e cientistas da vida tenham aumentado e melhorado nas últimas décadas, ainda há muito a ser feito nesta relação. Uma delas é a melhoria urgente do sistema de saúde, pois embora a tecnologia seja importante para melhorar o diagnóstico e o tratamento, também é necessário superar os complexos problemas de cobertura, qualidade, eqüidade e cuidado oportuno que os pacientes sofrem em muitas partes do mundo. Os governos devem ter orçamentos adequados para atender às necessidades de saúde de seus cidadãos e fortalecer o sistema para expandir a cobertura e melhorar a qualidade. Estas são tarefas pendentes que devem ser abordadas pela engenharia especializada para administrar e organizar sistemas, trabalhando harmoniosamente com cientistas da saúde e envolvendo pacientes, médicos, governos, fabricantes, outras disciplinas e a sociedade em geral.

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BACKGROUND: The anterior cruciate ligament (ACL) takes part in the knees articular cinematic regulation, which is why its rupture should be repaired as soon as possible. The surgical treatment is targeted to substitute the ruptured ACL with a graft that recreates the anatomical and biomechanical functions. Nevertheless, there are different factors that may produce a second rupture. OBJECTIVE: To determine the risk factors and frequency of failure in the ACL reconstruction. MATERIAL AND METHODS: Retrospective study evaluating the frequency and etiology of the failure in the ACL reconstruction in an adult population during a three-year period. Risk factors such as age, gender, trauma background, previous joint injuries, type of the graft previously used, lapse between surgeries, lapse between rupture and surgery and other comorbidities were analyzed. RESULTS: We obtained 34 patients with ACL reconstruction failure and 111 with native ACL rupture (145 patients in total). In the ACL reconstruction failure group, 31 were males with an average age of 33 years, produced by a traumatic mechanism (85.2%) and with other associated injuries (41%). CONCLUSIONS: We found a significant statistical association for graft failure with male patients, traumatic mechanism, isolated cartilage lesions or combined articular injuries.

El ligamento cruzado anterior (LCA) participa en la regulación de la cinemática articular de la rodilla, por lo que su ruptura debe repararse lo antes posible. El tratamiento quirúrgico está encaminado a la sustitución del LCA roto por un injerto que lo reemplazará tanto anatómica como biomecánicamente. Sin embargo, se pueden presentar diferentes condiciones que produzcan una rerruptura.

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En el transcurrir de la historia de la ciencia, se presentan diversos momentos en los que sus protagonistas han dejado su legado impreso. Aunque el dinamismo de la ciencia no permite su estancamiento en el tiempo, cada era la impregna de hechos, realidades y coyunturas que se deben analizar desde una mirada analítica e imparcial. En este artículo se presenta uno de esos análisis con el objetivo de definir qué es y qué no es ciencia, y se intenta responder al interrogante de para qué se hace ciencia, todo con una visión de disciplinariedad científica.

In the course of history of science had presented many times when its protagonists have left their legacy printed. Although the dynamism of science does not allow stagnation in time, each was impregnated with facts, realities, and situations that should be analyzed from an analytical and unbiased look. This article presents one such analysis to define what is and is not science, and attempts to answer the question of what is science done for all from a vision of scientific disciplinarity.

No curso da história da ciência tinha apresentado muitas vezes quando seus protagonistas não deixaram o seu legado impresso. Embora o dinamismo da ciência não permite que a estagnação no tempo, cada um foi impregnado com fatos, realidades e situações que devem ser analisados a partir de um olhar analítico e imparcial. Este artigo apresenta uma tal análise para definir o que é e não é ciência, e tenta responder À questão sobre o que é ciência feita para, tudo a partir de uma visão de disciplinaridade científica.

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PURPOSE: To show the clinical results of the treatment of brain metastases via radiosurgery using Volumetric Modulated Arc Therapy (VMAT). MATERIALS AND METHODS: 52 patients having lung (62 %), breast (17 %), colorectal (8 %) and other cancers (13 %) with one to three brain metastases were treated with 5 non-coplanar VMAT arcs. The treatment dose varied from 12 to 20 Gy, administered in one single session. The volume of metastases ranged from 0.04 to 24.92 cc. Radiosurgery alone was used for 54 % of cases, while 19 % received whole brain radiotherapy due to relapse. Patients were classified according to the Disease-specific graded prognostic assessment (DS-GPA) index and survival was assessed via the Kaplan-Meier model. RESULTS: The median survival time was 7.2 months from the date of radiosurgery. The Karnofsky and DS-GPA indices were the most significant with regard to survival. Patients with a Karnofsky performance status (KPS) over 70 had a longer survival time of 9.2 months, as opposed to those with a KPS below 70 of 3.5 months. No significant differences were found with regard to the type of cancer or the number of lesions. Local tumour control was achieved for 42 metastases (82 %), of which a complete response was achieved for 7 lesions, a partial response for 21; 15 lesions were stabilized. Local progression was observed in 8 lesions (15 %). The median treatment time per patient was 29 min. CONCLUSIONS: The VMAT technique proves to be safe and effective for treating brain metastases via radiosurgery.

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INTRODUCTION: Nutritional support (NS) leads complications that must be detected and prompt treated. OBJECTIVE: To estimate the incidence of some complications of nutritional support in critically ill patients. MATERIALS AND METHODS: A multicenter, descriptive, prospective study in patients with NS in intensive care units. Studied variables included medical diagnosis, nutritional status, length of NS, path, type of formula and ten complications. RESULTS: 419 patients evaluated, 380 received enteral nutrition (EN) and 39 parenteral nutrition (PN). The high gastric residue was the most incident complication in the ENS (24.2%), followed by diarrhea (14%) and withdrawal tube (6.6%). The high gastric residue and diarrhea were associated with the duration of the NS (p < 0.05). For the PNS the complication most incidents were hypophosphatemia (38.5%), followed by catheter sepsis (15.4%). The duration of the NS was associated with cholestasis, sepsis and hypophosphatemia (p < 0.05). CONCLUSIONS: complications of highest incidence were the high gastric residue for EN and hypophosphatemia for the PN; the withdrawal of the tube is a complication that claims further monitoring. The duration of the NS was the variable that showed greater association with the complications studied. Is a must to get consensus on complications definitions for comparisons establishment and best international standards target, furthermore propose protocols in order to decrease complications incidence of NS to fulfill the critical ill patient requirements.

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INTRODUCTION: Hyaluronic acid is a major component of synovial fluid and cartilage; it plays an essential role in joint function. This concept is based on the hypothesis that intraarticular sodium hyaluronate injections improve articular function upon restoring synovial fluid viscosupplementation and promoting endogenous synthesis. MATERIAL AND METHODS: Forty randomly selected patients older than 50 years of age, with a diagnosis of gonarthrosis, standard treatment-naïve, were divided into two 20-patient groups. The first group was treated with five 2.5 ml doses of hyaluronic acid, at one dose per week. The second group was treated with a single 2 ml dose of intraarticular methylprednisolone. A survey containing the Womac functional scale and the pain visual analogue scale was applied to both groups before and 3 months after treatment. RESULTS: A statistically significant reduction in pain (visual analogue scale) was observed 3 months after treatment in group H (1.6 +/- 0.88) and group M (2.95 +/- 1.84), as well as a functional post-treatment improvement in the Womac scale. Results for post-treatment pain were 5.43 +/- 1.05 for group H and 7.86 +/- 0.77 for group M; results for post-treatment stiffness were 3.05 +/- 0.82 for group H and 3.7 +/- 0.85 for group M; and finally for post-treatment functional capacity the results were 12.25 +/- 0.82 for group H and 18.95 +/- 0.85 for group M. CONCLUSION: Intraarticular sodium hyaluronate is more effective for pain and function than methylprednisolone. However, it involves higher costs than conservative treatment and fewer costs than surgical treatment, as well as the discomfort resulting from repeated intraarticular injections and the possibility of anaphylactic reaction.

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Objetivos: Conocer las complicaciones, las tasas de cura subjetiva y valoración con el índice de severidad de Sandvik a largo plazo de pacientes en quienes se realizó cistouretropexia laparoscópica tipo Burch para la corrección de su incontinencia urinaria de esfuerzo (IUE). Método: Análisis descriptivo, retrospectivo. Nivel de evidencia III. Se incluyeron las pacientes con diagnóstico de IUE tipo Blaivas IIB, a quienes se les practicó Burch laparoscópico en la Clínica del Prado y Profamilia Medellín, entre los años 2003 y 2007. Las variables principales a evaluar fueron edad, tiempo quirúrgico, cura subjetiva, índice de severidad de Sandvik y complicaciones. Resultados: Se analizaron 72 pacientes con promedio de edad de 46,57 +/- 9,54 años. El tiempo promedio de seguimiento fue de 24,4 meses (rango: 9,0-55,8 meses). El tiempo quirúrgico promedio fue de 79,83 minutos (rango: 44-160 minutos). Refirieron cura subjetiva 56 pacientes (77,8 por ciento). El índice de severidad de Sandvik muestra que a largo plazo 56,9 por ciento pacientes estaban secas con remisión completa de los síntomas y el 13,8 por ciento pacientes tenían pérdidas leves. Conclusiones: El Burch laparoscópico es una opción efectiva para el manejo de la incontinencia urinaria de esfuerzo tipo Blaivas IIB. Provee tasas de curación subjetiva a largo plazo similares a otros tipos de tratamiento. Es una opción más a tener en cuenta en el manejo de la IUE, en especial aquellas pacientes con patologías asociadas que se beneficien del abordaje por laparoscopia.

Objectives: To describe the subjective cure rate, the score of the Sandvik test and the complications after laparoscopic Burch in patients with stress urinary incontinence (SUI). Methods: Prospective descriptive study. We included all patients diagnosed with SUI Blaivas type IIB, and operated on by laparoscopy in two reference institutions between 2003 and 2007. Results: We analyzed 72 patients with an average age of 46.57 +/- 9.54 years. The average follow-up was 24.4 months, with a minimum of 9 and a maximum of 55.8. The average operating time in 29 patients in which we only performed laparoscopic Burch with or without colporrhaphy was 93.7 minutes (55-180 minutes); 56 patients (77.8 percent) reported subjective cure. The Sandvik's severity index found 56.9 percent dry patients and 13.8 percent with mild losses. Conclusion: The laparoscopic management may be useful in some patients, especially those who will be carried to laparoscopy by some other indication. Subjective cure rates are similar to other types of surgery.

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Objetivo: Describir los resultados de la histerectomía laparoscópica total ambulatoria. Método: Se analizan 297 pacientes sometidas a histerectomía laparoscópica total y que fueron dadas de alta luego de la recuperación anestésica, entre mayo de 2007 y marzo de 2008. Se requería una puntuación de menos de 5 en la escala visual análoga del dolor para el alta. Resultados: El promedio de edad fue de 42 años, el tiempo quirúrgico de 79,1 minutos, el sangrado estimado fue de 37,1 ml, el tiempo promedio de estancia total fue de 9,4 horas con un tiempo promedio de estancia postoperatoria de 5,4 horas. La tasa de complicaciones postoperatorias fue de 11,8 por ciento y la de readmisiones del 3,3 por ciento. El promedio de Escala Visual Análoga del dolor para la primera noche fue de 4,2 puntos. El 6 por ciento de las pacientes presentaron vómitos en su domicilio. El 99 por ciento de las pacientes recomendarían este tipo de manejo. Conclusiones: El manejo ambulatorio después de histerectomía laparoscópica total es posible, seguro y bien evaluado por las pacientes. Este manejo no conlleva un mayor riesgo de complicaciones y la tasa de readmisiones es baja.

Objective: To describe the results of a group of patients in which total laparoscopic hysterectomy was done as an outpatient procedure. Methods: We included 297 patients who were undergone to laparoscopic total hysterectomy, and were discharge to their home after recovery of anesthesia from may 2007 to march 2008. It was necessary to have a punctuation less than 5 in the analogue visual scale to be sent at home. Results: Mean age was 42 years, surgical time 79.1 minutes, estimated blood loss 37.1 ml, overall length of stay 9.4 hours, postoperative length of stay 5.4 hours. Postoperative complication rate was 11.8 percent, readmission rate was 3.3 percent. Mean VAS Score for pain during the first night was 4.2 points; 6 percent of patients vomited at home. Mean VAS Score for satisfaction with ambulatory management was 9.5, and 99 percent of the patients would recommend this type of management. Conclusions: Ambulatory management after total laparoscopic hysterectomy is possible, safe and well evaluated by patients. It does not impose a higher risk of complications and readmission rate is low.

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Objetivos: Comparar la curva de aprendizaje en histerectomía laparoscópica total (HLT) de 4 ginecólogos en la Clínica del Prado, Medellín, Colombia. Determinar el número de cirugías necesarias para alcanzar un tiempo quirúrgico promedio de 90 minutos, disminuir la laparoconversiones a un 3 por ciento o menos y disminuir las complicaciones totales a menos del 10 por ciento. Método: Se realizó un estudio de cohorte prospectivo que incluyó 626 pacientes operadas por 4 ginecólogos laparoscopistas con técnica y equipamiento quirúrgico similar. Se formaron 4 grupos de pacientes de acuerdo al orden en la casuística de cada uno de ellos. Resultados: El tiempo quirúrgico promedio de 93 minutos se logra con las primeras 50 HLT. El realizar entre 50-100 HLT baja las tasas de laparoconversión a 1,9 por ciento. La tasa de complicaciones en la sumatoria de la primera y segunda cohorte es de 19,4 por ciento y la tasa de complicaciones totales en la tercera cohorte es de 8,7 por ciento (RR: 0,45; IC95 por ciento: 0,26-0,78) la cual permanece en el límite deseado (10 por ciento) en la cuarta cohorte. Conclusiones: La curva de aprendizaje en HLT para lograr un promedio de tiempo de cirugía de 90 minutos se logra con las primeras 50 histerectomías. A pesar de las limitaciones metodológicas, el presente estudia revela que para lograr la destreza máxima toma entre 50-100 histerectomías para lograr laparoconversiones menores del 3 por ciento y entre 100-150 histerectomías para lograr complicaciones totales inferiores a 10 por ciento.

Objective: To compare the learning curve in total laparoscopic hysterectomy (HLT) from four gynecologists in the Clínica del Prado, Medellín, Colombia. To determine the number of surgeries required to achieve an average surgical time of 90 minutes, to reduce laparoconversions to 3 percent or less and to reduce total complications to less than 10 percent. Method: We performed a prospective cohort study including 626 patients operated by four gynecologists laparoscopist with similar technique and surgical equipment. We made four groups of patients according to the order in the cases of each one. Results: The mean operative time of 93 minutes is achieved with the first 50 HLT. Doing 50-100 HLT, laparoconversions rates low to 1.9 percent. The complication rate in the sum of first and second cohort is 19.4 percent and the total complication rate in third cohort is 8.7 percent (RR: 0.45; 95 percentCI 0.26-0.78) which remains in the desired limit (10 percent) in fourth cohort. Conclusions: HLT learning curve to achieve an average surgical time of 90 minutes is achieved with the first 50 hysterectomies. Despite the methodological limitations this study, shows that to achieve máximum expertise, it takes between 50-100 hysterectomies to achieve laparoconversions less than 3 percent, and between 100-150 hysterectomies to achieve total complications lower than 10 percent.

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La pancreatitis aguda es la inflamación aguda del páncreas con grado variable de compromiso de los tejidos regionales y diferente grado de compromiso sistémico. Se utilizan como definiciones las establecidas en el consenso de Atlanta (anexo 1). B. Diagnóstico 1. Historia clínica. Se presenta dolor en hemiabdomen superior, usualmente serio y acompañado de grados variables de vómito, náuseas y fiebre. Son importantes los antecedentes personales y familiares. 2. En el examen físico siempre se deben incluir el peso, la talla, el índice de masa corporal (IMC), la temperatura, la saturación de oxígeno (SAO2), la frecuencia cardiaca, la frecuencia respiratoria y la tensión arterial.

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