Enfermedad linfroproliferativa en trasplante renal y hepático / Linfophroliferative disease in kidney and liver transplantation on ther organ

La enfermedad linfoproliferativa post trasplante (PTLD) es la neoplasia más frecuente observada en receptores pediátricos de órganos sólidos. Analizamos 883 pacientes trasplantados: 547 trasplantes renales (TxR) y 336 trasplantes hepáticos (TxH). 44 de ellos desarrollaron un PTLD luego de estos procedimientos. La incidencia en TxR fue del 4.02 por ciento (22 de 547) y en TxH de 5.75 por ciento (22 de 336). El tiempo medio de la aparición del PTLD fue de 37.47 más menos 35 meses. Localización: cavun 50 por ciento, adenopatías cervicales 14.4 por ciento, masa abdominal 11.4 por ciento, adenopatías axilares e inguinales 9 por ciento, compromiso del SNC 4.5 por ciento, piso de la boca 4.5 por ciento , higado ortótopico 2.3 por ciento, páncreas 2.3 por ciento, injerto renal 2.3 por ciento. Los diagnósticos histopatológicos obtenidos fueron: hiperplasia plasmocitica 52.3 por ciento, lesiones polimorfas 20.5 por ciento, y lesiones monomorgas (linforma B o Linfoma de células grandes) 27.2 por ciento de los pacientes. El tratamiento indicado incluyó reducción de la inmunosupresión de mantenimiento en todos los pacientes, excéresis en 22 pacientes, anticuerpos antCD20 en 17 de ellos y quimioterapia (régimen de CHOP) en 6 pacientes. La sobrevida fue del 79 por ciento (IC 64 por ciento-88 por ciento) a 5 años de seguimiento. Conclusión: En nuestra serie la incidencia de PTLAD es similar a la de otros autores. La respuesta al tratamiento con disminución de la inmunosupresón, empleo de monoclonales, ha sido satisfactoria. El seguimiento cercano, el alto índice de sospecha para el diagnóstico precóz y la individualización de la inmunosupresión para cada paciente, fueron conductas eficaces.(AU)

Programa de trasplante hepático en el Hospital de Pediatría Juan P. Garrahan: 16 años de experiencia / Liver transplant program at the hospital de Pediatría Juan P. Garrahan: 16 years of experience

El propósito de este trabajo es mostrar la experiencia de 16 años del programa de traplante hepático del Hospital de Pediatría Juan P. Garrahan iniciado en Noviembre de 1992. Material y método: la metodología de este trabajo es de tipo retrospectivo, descriptivo y observacional. Se revisaron la base de datos del servicio y las historias clínicas de 430 pacientes que fueron sometidos a uno o más trasplantes hepáticos entre noviembre de 1992 hasta marzo de 2009, en nuestro hospital. Se describieron los datos demográficos, las indicaciones de trasplante, el tipo de injerto utilizado, la compatibilidad del rupo ABO entre el donante y el receptor, la relación de peso entre donante receptor, la utilización de injertos arteriales y venosos, las complicaciones quirúrgicas, los episodios de rechazo agudo y crónico, la severidad de los mismos, los episodios de infecciones, la incidencia de enfemedad linfoproliferativa, la sobrevida del injerto y del paciente y las causas de muerte. Resultados: desde noviembre de 1992 hasta marzo de 2009 se realizaron 469 trasplantes en 430 pacientes. La causa más frecuente de trasplante en nuestra serie es la atresia de vías biliares con 162 casos que representan el 34,5 por ciento de los pacientes. En 126 casos se realizó el trasplante con donante vivo emparentado, en todos ellos se utilizó el segmento lateral izquierdo (segmeto II-III) del donante. Los 343 restantes fueron efectuados con donantes cadavéricos donde a 298 higados se le efectuó algún tipo de reducción hepática. Las complicaciones más frecuentes fueron biliares: 58 (13,5 por ciento) pacientes tuvieron fístulas y 52 (12 por ciento) estenosis. Se comprobó trombosis de la arteria hepática en 23 pacientes y portal en 19. Presentaron 248 pacientes (52 por ciento) uno o más episodios de rechazo agudo celular. el rechazo cronico se presentó en 24 casos ( (5 por ciento). La sobrevida actuarial del paciente y del injerto fue de 74,45 por ciento y 72,5 por ciento al año. (AU)

Estudio comparativo de dos programas rurales / A comparative study of two rural programs

El objetivo del presente trabajo fue evaluar dos programas rurales realizados en niños que concurren a escuelas de Caraguatay, provincia de Misiones. Sobre una población de 40 niños de 7 años que se encuentran bajo programa de atención integral 1, con los primeros molares permanentes erupcionados, se realizó 1: 1- historia clínica, 2- cepillado mecánico y diagnóstico dentario. La muestra de 40 niños se dividió en dos grupos: Grupo 1 (n=20) al cual se le realizó 1 aplicación anual de bifloruro de amonio, y Grupo 2 (n=20) aplicación de selladores de fosas y fisuras. El examen basal registró: Grupo 1: CPOD, 0.15 +- 0.36; CPOS: 0,15 +- 0.36; Grupo 2: CPOD: 0.65 +- 0.30; CPOS: 0.65 +- 0.18. El examen al año registró: Grupo 1: CPOD: 0.45 +- 0.15; CPOS: 0.45 +- 0.15. Grupo 2: CPOD: 1.5 +- 0.30; CPOS: 1.5 +- 0.30. A los dos años la evaluación del programa registró para losmismos grupos una media para el componente C de 0.40 +- 0,18 en el grupo 1 y de 0.60 +- 0.13 para el Grupo 2, sin diferencias significativas entre ambos grupos. Luego de dos años de programa con aplicación de barniz de bifluoruro de amonio entre el 10 por ciento y el 40 por ciento de los molares reigstraron remineralización en los surcos mientras que el Grupo 2 al cabo de 2 años entre el 25 por ciento y el 60 por ciento mantuvo el sellador. Conclusión: en ambos programas rurales, la aplicación de barnices fluorados y de selladores de fosas y fisuras resultó efectiva para el control del componente C del CPOD (AU)

Evolución de niños post-trasplante hepático luego del primer año de sobrevida / Evolution of children one year post liver transplant

Orthotopic liver transplantation is the only definitive mode of therapy for children with end-stage liver disease. However, it remains challenging because of the necessity to prevent long-term complications. The aim of this study was to analyze the evolution of transplanted patients with more than one year of follow up. Between November 1992 and November 2001, 238 patients underwent 264 liver transplantations. A total of 143 patients with more than one year of follow up were included. The median age of patients +/- SD was 5.41 years +/- 5.26 (r: 0.58-21.7 years). All children received primary immunosuppression with cyclosporine. The indications for liver replacement were: fulminant hepatic failure (n: 50), biliary atresia (n: 38), cirrhosis (n: 37), chronic cholestasis (n: 13) and miscellaneous (n: 5). The indications for liver re-transplantation were: biliary cirrhosis (n: 7), hepatic artery thrombosis (n: 4) and chronic rejection (n: 3). Reduced-size liver allografts were used in 73/157 liver transplants, 14 of them were from living-related donors and 11 were split-livers. Patient and graft survival rates were 93% and 86% respectively. Death risk was statistically higher in retransplanted and reduced-size grafted patients. Growth retardation and low bone density were recovered before the first 3 years post-transplant. The incidence of lymphoproliferative disease was 7.69%. De novo hepatitis B was diagnosed in 7 patients (4.8%). Social risk did not affect the outcome of our population. The prevention, detection and early treatment of complications in the long-term follow up contributed to improve the outcome.(AU)

Detección por técnicas de biología molecular de Mycoplasma hominis y Ureaplasma urealyticum en muestras urogenitales / Detection by molecular biology techniques of Mycoplasma hominis and Ureaplasma urealyticum in urogenital samples

Mycoplasma homonis y Ureaplasma urealyticum están estrechamente relacionadas con enfermedades del tracto urogenital como pielonefritis, uretritis no-gonocóccica, cálculos urinarios, epididimitis, inflamaciones pélvicas, infertilidad, abortos y fiebre post-parto; en recién nacidos también pueden causar neumonías y meningitis. Estas bacterias pueden ser diagnosticadas por diferentes métodos. En este trabajo utilizamos la hibridación de ácidos nucléicos y la reacción en cadena de la polimerasa para analizar 22 muestras de pacientes con diferentes síntomas urogenitales, en busca de micoplasmas y ureaplasmas. Como resultado obtuvimos 10 muestras positivas y 12 negativas. Entre las muestras positivas se identificaron 2 como Mycoplasma hominis, 2 como Ureaplasma urealyticum y 6 con ambas especies. los resultados obtenidos por las técnicas moleculares fueron comparados con los métodos de referencia, encontrándose en 18 muestras resultados coincidentes, mientras que en 4 los resultados fueron discordantes, siendo esta diferencia estadísticamente no significativa (AU)

Oral health of children from rural excluded villages (Trancas and Calchaqui valleys. Tucumán, Argentina).

The general hypothesis of the study was to evaluate strategically important rural areas to confirm their characteristics of [quot ]excluded population[quot ] and identify the priorities to allocate human and financial resources of the international co-operation project. The aim of this study was to establish the degree of development of villages in the Trancas and Calchaqui valleys, and the oral health of children living in areas involved in an integral study on excluded villages in the northwest of Argentina. These villages are considered a priority in the UNIR Project; they are thus strategically important as a link with countries of the MERCOSUR. Data on living conditions were obtained through direct inquiries (Project UNIR, W. K. Kellogg Foundation/University of Tucumán) and from data supplied by the Ministry of Economy, by the Ministry of Culture and Education and by the SIEMPRO project of the Secretariat of Social Development of the Ministry of Health. The Human Development Index (HDI) was calculated as World Bank criteria (1995), The studies on dental conditions were carried out in all the children between 12 and 14 years old, that is a total of 58 in the Trancas Valley and 212 in the Calchaqui Valley. RESULTS: (1) The HDI was 0.731 for the province, 0.56 for the Trancas Valley and 0.51 for Calchaqui valley. (2) The results are above the values for the country in the first case, and below the average country values for the valleys. (3) The percentage of BNN families reached 92

. The results for oral health show: (4) the DMFT were 6.34 +/- 0.07 in the Trancas Valley and 7.47 +/- 0.276 in the Calchaquí valley. (5) Carious teeth (CT) were the most important component of this index. (6) The absence of a specific and preventive assistance. CONCLUSIONS: (a) Children between 12 and 14 living in the Valleys of Trancas and Calchaqui (Tucumán, Argentina) are affected by severe levels of caries, with values above the national and province means. (b) The human development index is below that of the corresponding national and province levels. (c) Inhabitants of these valleys can be identified as socially and biologically highly vulnerable. (d) The indicators of cariogenic risk reveal the importance of introducing oral preventive care components to the health plan for the area focused on the excluded population.

Prevalencia de anticuerpos para Flavivirus en el primate Alouatta caraya autoctono de la Argentina. / [Prevalence of Flavivirus antibodies in Alouatta caraya primate autochthonous of Argentina]

Flavivirus constitute a human health problem in our country. Primates are known to participate in the maintenance of Dengue and Yellow Fever viruses. However, these animals play a role which still remains to be determined in the maintenance of other viruses with potential pathogenicity for human beings and/or animals. Detección of antibodies was performed for different flavivirus in 105 sera samples of Alouatta caraya primates by the hemagglutination inhibition (HI) test. The neutralization (NT) test confirmed only infections caused by St. Louis Encephalitis (SLE) virus with a high prevalence in HI (35.23

) and NT (32.38

) antibodies. No antibody titres indicative of infections by Yellow Fever, Dengue and Bussuquara viruses were registered. Infection by the liheus virus could not be confirmed in these primates. There is a need for studies to detect new or reemergent viral infections in Argentina and the role that these primates could play in the maintenance of such infections.

Oral health of children from rural excluded villages (Trancas and Calchaqui valleys. Tucumán, Argentina)

The general hypothesis of the study was to evaluate strategically important rural areas to confirm their characteristics of [quot ]excluded population[quot ] and identify the priorities to allocate human and financial resources of the international co-operation project. The aim of this study was to establish the degree of development of villages in the Trancas and Calchaqui valleys, and the oral health of children living in areas involved in an integral study on excluded villages in the northwest of Argentina. These villages are considered a priority in the UNIR Project; they are thus strategically important as a link with countries of the MERCOSUR. Data on living conditions were obtained through direct inquiries (Project UNIR, W. K. Kellogg Foundation/University of Tucumán) and from data supplied by the Ministry of Economy, by the Ministry of Culture and Education and by the SIEMPRO project of the Secretariat of Social Development of the Ministry of Health. The Human Development Index (HDI) was calculated as World Bank criteria (1995), The studies on dental conditions were carried out in all the children between 12 and 14 years old, that is a total of 58 in the Trancas Valley and 212 in the Calchaqui Valley. RESULTS: (1) The HDI was 0.731 for the province, 0.56 for the Trancas Valley and 0.51 for Calchaqui valley. (2) The results are above the values for the country in the first case, and below the average country values for the valleys. (3) The percentage of BNN families reached 92

. The results for oral health show: (4) the DMFT were 6.34 +/- 0.07 in the Trancas Valley and 7.47 +/- 0.276 in the Calchaquí valley. (5) Carious teeth (CT) were the most important component of this index. (6) The absence of a specific and preventive assistance. CONCLUSIONS: (a) Children between 12 and 14 living in the Valleys of Trancas and Calchaqui (Tucumán, Argentina) are affected by severe levels of caries, with values above the national and province means. (b) The human development index is below that of the corresponding national and province levels. (c) Inhabitants of these valleys can be identified as socially and biologically highly vulnerable. (d) The indicators of cariogenic risk reveal the importance of introducing oral preventive care components to the health plan for the area focused on the excluded population.

Crisis porfírica. Experiencia con 30 episodios. / [Porphyric crisis: experience of 30 episodes]

The experience of 30 porphyric crisis is reviewed in 25 patients attended since 1967: 21 patients had 1 crisis, 3 had 2, and 1 had 3 of these episodes. In all patients, porphyria was diagnosed in relation to one crisis, even though many of them had family histories and/or previous clinical symptoms of this disease. There was clear predominance (80

) of women, but they are also a majority among acute porphyrias. The most frequent symptoms were: abdominal pain, tachycardia, dark urine, neurological and psychiatric alterations and arterial hypertension. The neurological alterations required the use of a respirator in 9 crisis (33

), which was maintained in 2 patients during 4 months. In 6 crisis (20

) there were no neurological symptoms. Among laboratory tests, hyponatremia was notable for its frequency (53.4

) and intensity. Increase in urinary porphobilinogen, a requirement for diagnosis, between 15 and 130 times the normal value was observed. Septic complications, such as pneumonia, septicemia, and urinary infection, were frequent (50

). Factors suspicious of triggering crisis episodes were: drugs, usually more than 2, in 50

of the cases; pregnancy in 30

of the women and in a lesser proportion, intense exercise, and surgery. In 10 patients, crisis triggering factors were not identified or informed. The role of pregnancy, childbirth delivery or puerperium in causing a crisis is not clear, because the patients who had a crisis related to them had 15 other pregnancies without incidents; besides, in the pregnancy which was accompanied by a crisis, there was always one or more than one potentially triggering drug present. The first therapeutic step was oral and/or parenteral administration of an overload of carbohydrates and, if there was no response, intravenous infusion of hematin was prescribed. Four (13.3

) patients died even though they had received hematin, but it had been administered too late due to a delay in diagnosis. In surviving patients, there were no organic sequels of any kind.

Pruebas de sensibilidad in vitro para levaduras: evaluación de un micrométodo. / [In vitro sensitivity tests for yeasts: evaluation of a micromethod]

A microdilution antifungal susceptibility test for yeasts was evaluated, based on the macro broth dilution method standardized by the National Committee for Clinical Laboratory Standards (NCCLS) Subcommittee on Antifungal Susceptibility Testing. Both methods were compared using six reference strains with different patterns of susceptibility to the following antifungal drugs: amphotericin B (AMB), flucytosine (5FC), fluconazole (FCZ), itraconazole (ITZ), ketoconazole (KTZ) and miconazole (MCZ). Minimal inhibitory concentration (MIC) results obtained by both methods differed only in 1 or 2 dilutions. Microdilution MICs determined as visual endpoints and as quantitative measurement of 80

inhibition of relative growth showed a significant correlation (p < 0.001) for AMB, 5FC, FCZ, MCZ and ITZ, conversely no correlation (p = 1.00) for KTZ was observed as determined with 47 local isolates of Candida albicans.

Fibrohistiocitoma maligno sobre radiodermitis / Malignant fibrous histiocytoma over radiodermitis

Se prsentan dos casos clínicos de fibrohistiocitoma maligno sobre radiodermitis. El primer caso se trata de un paciente de sexo masculino que presenta una lesión tumoral en mejilla derecha, zona de radiodermatitis crónica provocada por tratamiento de acné 25 años atrás. Luego de la escisión quirúrgica la lesión recidivaal año. En el segundo caso una paciente de sexo femenino portadora de carcinoma mamario presenta una lesión tumoral compatible con fibrohistiocitoma maligno localizada en cara anterior de tórax, sobre una radiodermitis crónica por tratamiento de cobalto realizado por su patología de base 23 años atrás. Se derivó al srvicio de cirugía, pero la paciente fallece antes por metástasis del carcinoma. Dada la escasa frecuencia de esta patología se realiza una revisión bibliográfica del tema (AU)

Pruebas de sensibilidad in vitro para levaduras: evaluación de un micrométodo / In vitro susceptibility tests for yeasts: evaluation of a micromethod

Se evaluó un micrométodo para la realización de pruebas de sensibilidad de levaduras frente a antifúngicos, basado en el macrométodo en medio líquido estandarizado por el National Committee for Clinical Laboratory Standards (NCCLS) Subcommittee on Antifungal Susceptibility Testing. En este trabajo se compararon ambos métodos utilizando 6 cepas de referencia de diferente sensibilidad a los siguientes antifúngicos, anfotericina B (AMB), flucitosina (5FC), fluconazol (FCZ), itraconazol (ITZ), ketoconazol (KTZ) y miconazol (MCZ). Se observaron variaciones de sólo 1 ó 2 diluciones entre los resultados de las concentraciones inhibitorias mínimas (CIM) obtenidas con las dos técnicas. Asimismo, se compararon las lecturas visuales de CIM por micrométodo con las mediciones turbidimétricas del crecimiento en distintas concentraciones de antifúngicos frente a 47 aislamientos de Candida albicans. Existió una correlación significativa (p<0.001) entre CIM visual y la inhibición del 80 por ciento de crecimiento determinada por turbidimetría con AMB, 5FC, FCZ, ITZ y MCZ; en cambio no hubo correlación alguna para KTZ (p=1.00) (AU)

Función diastólica en la enfermedad de Chagas. / [Diastolic function in Chagas disease]

With the purpose of analyzing diastolic function in Chagas, disease (ECh), 42 patients were studied: 31 males (aged 33 +/- 9), 22 of them with positive serology for ECh and 9 with negative serology; 11 female patients (aged 36 +/- 12), 10 with positive serology and 1 with negative serology. In all patients 2 D-Echo and simultaneous EKG, phonocardiogram, apexcardiogram and M-mode Echo at 100 mm/sec were taken. The A2-D, A2-O (total apexcardiographic relaxation-RAT), a/D (diastolic amplitude of [quot ]a[quot ] wave), ITRAT = A2 - C/RAT, DDVI, DSVI, shortening fraction (FA) and percentage of dimension changes (D D

) were determined. The patients were divided into 4 groups: G - A (n = 10) normal; G - B (n = 15) positive serology, with EKG and Rx and FA normal; G - C (n = 10) positive serology, abnormal EKG, and normal Rx and FA; G - D (n = 7) positive serology, abnormal EKG, mild cardiomegalia and diminished FA. The patients from group B presented significative modification, 46& (7/15) of the FD indexes and those from group D with 70

(5/7), as well as of D D C - E and D D Dm-0 indicative of uncoordinated contraction and relaxation. A progressive worsening of the FD from G - D was observed, reaching in this last one statistically significant values. In the ECh the alterations in the FD precede the systolic, which allows for an early detection of myocardiac damage by noninvasive techniques.

Criterios de bajo riesgo de mortalidad en niños con neutropenia y fiebre durante la quimioterapia por cáncer. / [Criteria of low risk of mortality in children with neutropenia and fever during cancer chemotherapy]

To validate the use of a lower-risk mortality profile in pediatric febrile neutropenia during anticancer therapy and to evaluate the efficacy of a sequential parenteral-oral antibiotic treatment for these children, a prospective study was conducted between May 1997 and December 1999. During this period 247 episodes in 215 patients were included in the present study. Children with neutropenia (ANC < 500/mm3) and fever (> 38 degrees C) due to anticancer therapy were eligible for the study if they presented the following lower-risk conditions: absence of severe co-morbidity factors, good clinical condition, no risk clinical foci, no bacteremia, and responsible parents. They were initially treated with inpatient parenteral short course of ceftriaxone and amikacin followed by ambulatory oral cefixime or ciprofloxacin to complete 7 days. Mean age was 64 (range: 8-200) months. The most common underlying malignant disease was acute lymphoblastic leukemia in 48

(118) of cases and 57

(141) of patients had an indwelling central venous catheter. Clinical evidence of infection was found in 47

(122) of children and the most common site was the upper respiratory tract (81

). Mean period of fever was 1.1 days (r: 1-8) and the duration of neutropenia was 3.9 days (r: 1-9). Sixty-one

(150) of children was discharged with neutropenia. Mean time of hospitalization was 1.5 days. Four clinical failures were detected (1.6

). They all were satisfactorily treated with a secondary treatment and none underwent any major complications or died. The lower-risk profile used was safe and the sequential antibiotic therapy was adequate to manage febrile neutropenia in this subset of children.

Función diastólica en la enfermedad de Chagas / Diastolic function in Chagas disease

Con el objetivo de analizar la función diastólica (FD) en la enfermedad de Chagas (ECh), se estudiaron 42 pacientes (p): 31 hombres (33 + o - 9 años), 22 de los cuales tenían serología poositiva para ECh y 9 serologia negativa; 11 mujeres (36 + o - 12 años), 10 con serología positiva y 1 con serología negativa. A todos los p se les realizó ECG 2 - D y registro simultáneo de ECG, fonocardiograma, apexcardiograma y ECO-M a 100 mm/seg. Se midió el tiempo A2 - D, A2 - 0 (relajación apexocardiográfica total - RAT), a/D (amplitud diastólica de la onda "a"), ITRAT = A2 - C / RAT, DDVI, DSVI, fracción de acortamiento (FA) y procentaje de variación de dimensión. Los p fueron divididos en 4 grupos: G - A (n = 10) normales, G - B (n = 15) serologiía positiva (S+), ECG, Rx y FA normal; G - C (n = 10) S+, ECG anormal, Rx y FA normal y G - D (n = 7) S+, ECG anormal, Rx con cardiomegalia leve y FA disminuida. Los p del G - B presentaron alteraciones significativas del 46% (7/15) de los índices de FD y los del G D del 70% (5/7), indicando contracción y relajación incoordinada. Se observó un progresivo deterioro de la FD del G - B al G - D, alcanzando en este último valores de significación estadística. En la ECh las alteraciones de la FD preceden a las sistólicas consideradas, permitiendo detectar daño miocárdico precoz mediante técnicas no invasivas (AU)

Manifestaciones cutáneas de la anorexia y bulimia / Dermatological aspects in bulimia and anorexia nervosa

Se analizan los aspectos dermatológicos de 100 pacientes con patología de la conducta alimentaria, de los cuales 60 correspondieron a bulimia nerviosa (BN) y 40 a anorexia nerviosa (AN). La mayoría eran de sexo femenino, con edad promedio de 17 años. Fueron características comunes de ambas patologías xerosis, acné, alopecia y caries, destacándose en BN dermatitis artefacta, carotenodermia y signo de Russell y en AN hipertricosis y amenorrea. Se enfatiza la importancia del reconocimiento de estos cuadros que están en crecimiento y donde el diagnóstico precoz es fundamental para iniciar un tratamiento adecuado (AU)