[Cartagena Declaration. The International Declaration on the Right to Nutritional Care and the Fight against Malnutrition].

The need to promote the right to nutritional care, to fight against malnutrition and to advance in education and research in clinical nutrition has led all the FELANPE's societies to sign on May 3rd, during the 33rd Congress of the Colombian Clinical Nutrition Association (ACNC) in the city of Cartagena, the International Declaration on the Right to Nutritional Care and the Fight against Malnutrition, "Declaration of Cartagena". The Declaration provides a coherent framework of 13 principles which can serve as a guide for societies, schools and associations affiliated to FELANPE in the development of action plans. In addition, it will serve as an instrument to promote, through governments, the formulation of policies and legislation in the field of clinical nutrition.

Hospital Malnutrition Related to Fasting and Underfeeding: Is It an Ethical Issue?

Hospital malnutrition is a relevant clinical issue present in about 50% of patients that is associated with increased morbidity, mortality, and cost of care. Because of the relation of malnutrition with chronic and acute inflammatory processes secondary to disease, nutrition therapy is considered an important medical treatment. However, there is little discussion about the impact of another critical issue related to hospital malnutrition, that is, lack of appropriate food or nutrition therapy given to the patients.

[Chain of errors in laparoscopic appendectomy].

Background: The urachal cyst is a rare pathology in the adult patient and in general is asymptomatic. The goal of this presentation is to learn of the errors.

Clinical Case: A 22 year old female with clinical diagnosis of acute appendicitis was taken to surgical management.

[Errors in surgery. Strategies to improve surgical safety].

Surgery is an extreme experience for both patient and surgeon. The patient has to be rescued from something so serious that it may justify the surgeon to violate his/her integrity in order to resolve the problem. Nevertheless, both physician and patient recognize that the procedure has some risks.

Fibrin glue as adjuvant treatment for gastrocutaneous fistula after gastrostomy tube removal.

Gastrocutaneous fistulas are infrequent after gastrostomy tube removal. However, if the fistulous tract remains permeable, even low-volume output can produce significant cutaneous burns. The use of biodegradable adhesives has been described, where fibrin glue is applied directly over the fistulous tract or under the guidance of procedures such as upper or lower gastrointestinal endoscopy or fistuloscopy.

L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis.

Background & Aims: A growing number of randomized clinical trials suggest that glutamine (Gln) supplementation may be beneficial in a selected group of patients and conditions. However, the effects of Gln-enriched total parenteral nutrition (TPN) on recovery from acute intra-abdominal infection have not been thoroughly investigated. Therefore, the aim of this study was to investigate whether the provision of Gln-enriched TPN after surgical and medical treatment of secondary peritonitis improves infectious morbidity.

Complications of central venous catheters.

Central vein catheterization is frequently employed for monitoring, administration of drugs and parenteral nutrition in a variety of medical and surgical illnesses. Despite the widespread use of central vein access, both catheter-related infections and mechanical complications remain unacceptably common. In the last few years, data have become available to show that technical innovations and catheter maintenance protocols can reduce both catheter related bloodstream infections as well as mechanical complications.

Retained foreign bodies following intra-abdominal surgery.

Background/aims: A retained foreign body in the abdominal cavity following surgery is a continuing problem. Despite precautions, the incidence is grossly underestimated. The purpose of this study is to report the result of surgical treatment on 24 consecutive cases treated by the authors during a 10-year period.

[Massive hemorrhage of the digestive system secondary to ulcerated colonic malacoplakia].

A case of malakoplakia of the colon in a 55-year-old female patient with a massive hemorrhage of the rectum is reported. A barium enema showed polypoid lesions (pseudopolyps). Colonoscopy revealed white-yellowish nodules simulating small pustulae all along the colon at 2 cm from the anal verge.

[Morbidity, mortality, and total parenteral nutrition in esophageal and gastric surgery for benign pathology].

We performed a retrospective study in patients undergoing mayor elective surgery of the upper gastrointestinal tract for benign disease receiving perioperative total parenteral nutrition (TPN). We analyzed the clinical charts from patients admitted to the Hospital de Especialidades del Centro Médico de Occidente for this purpose from January 1983 to March 1987, selecting those who had clinical or laboratory criteria of severe malnutrition. They were divided in two groups depending on whether TPN was being indicated as preoperative preparation and continued through the postoperative period (GE = 32 patients), or initiated after surgery (GC = 13 patients).

[Surgical revision and correction of choledochal cysts].

Choledochal cyst are a rare congenital abnormality, seldom treated by the General Surgeon. We report six cases of re-operation found on a eighth year period. Six cysts type I, and one type II (Todani's Classification) were found.

[Post-traumatic diaphragmatic rupture. Report of 20 cases].

From 1977 to 1987, 20 patients (18 men and 2 women) with left post-traumatic diaphragmatic rupture, were managed by the General Surgery Service of the Hospital de Especialidades, Centro Médico de Occidente, IMSS; 13 as urgencies (65%) and 7 as elective procedures (35%). Hernia was due to closed trauma in 80% of the cases. Predominant symptoms were chest pain (85%) and dyspnea (50%).

[Complications of the surgical treatment of reflux esophagitis].

The complications presented by 36 patients submitted to anti-reflux procedures that were treated in our Hospital in a 10 year period, from September 1978 to May 1988, are analyzed. The patients were divided in 2 groups depending on the initial treatment being performed inside or outside our Hospital. The indication for the initial operation was reflux esophagitis in all patients, 4 or whom, had developed a shortened esophagus with stenosis.

[Artificial nutrition. When? How? What?].

The association of excessive morbidity and mortality with malnourished states has been well documented. Nutritional assessment should now be an integral part of the evaluation of all hospitalized patients, particularly those scheduled for surgical procedures. Determination of the method of feeding the patient depends on the patient's nutritional status, the level of gastrointestinal function and the type and magnitude of treatment which he will undergo.