[Non-surgical treatment of Dupuytren's disease by using percutaneous needle aponeurotomy: A 10-year experience]. / Tratamiento no quirúrgico de la enfermedad de Dupuytren con aponeurotomía percutánea con aguja: 10 años de experiencia.

INTRODUCTION: Dupuytren's disease is a fibroproliferative disorder of the palmar aponeurosis that leads to digital flexion contractures. This disabling condition can be treated with a minimally invasive procedure, called percutaneous needle aponeurotomy (PNA). OBJECTIVE: To report the results of 10 years of experience treating Dupuytren's contracture by PNA in the rheumatology hand unit of our department. METHODS: We conducted a retrospective study with a description of method to perform PNA and analysis of post-procedure results. RESULTS: There were 197 patients with Dupuytren's disease. Ninety-eight patients (49.7%) underwent PNA, corresponding to 117 treated fingers. Good immediate results were achieved in 84% of the patients, with results being better in those with less advanced stages. Recurrences occurred in 12% of the patients. The complication rate was 1.7%. CONCLUSION: Our results confirm the value of this technique especially in the early stages of Dupuytren's disease, with immediate satisfactory results and a low rate of complications.

[A superior vena cava syndrome due to a surgical retractor]. / Síndrome de vena cava superior por retractor quirúrgico.

A 56-year-old male diagnosed of epidermoid carcinoma of the right lung (T4 N0 M0, stage IIIb) is described. He had earlier received chemotherapy and radiotherapy and was scheduled for removal of the right lung. During surgery the need to resect tumor infiltration of the right atrium became evident. During weaning from by-pass sudden deterioration of hemodynamics occurred with poor response to volume and inotropic drugs. Superior vena cava syndrome due to traction of the innominate trunk from a surgical retractor was diagnosed; the crisis resolved when the retractor was withdrawn. We discuss the pathophysiology of this clinical picture and relevant intraoperative aspects.

[Exercise-induced bronchospasm in asymptomatic asthmatic children. Incidence and characterization of the response in comparison with normal children]. / Broncospasmo inducido por ejercicio en niños asmáticos asintomáticos. Incidencia y caracterización de la respuesta en comparación con niños normales.

Four-hundred and eighty five asthmatic children and twenty-nine controls underwent exercise challenge consenting of running up and down a flight of stairs over five to eight minutes. An exercise-induced bronchospasm was considered to occur if the FEV1 fell over 15% or the MMEF 25%-75% over 25% from the pre-exercise values. There was an incidence of 38.5% positive responses in asthmatics and none was observed in controls. The peak fall of both flow indexes occurred at five minutes post-exercise. The MMEF 25%-75% was more sensitive in the detection of the EIB. It was noticed a seasonal variation in the incidence of the EIB.

[Rhabdomyoma of the heart: three case report (author's transl)]. / Rabdomioma cardiaco. Aportación de tres nuevas observaciones.

Authors described three infants under three months of age with cardiac rhabdomyoma observed during a period of eight years. There was no clinical or pathological evidence of tuberous sclerosis. During this period of time they found two cases of tuberous sclerosis, without associated rhabdomyoma, among 2,457 necropsies. On the other hand none of 11 children with tuberous sclerosis under observation in this centre had any clinical evidence of rhabdomyoma. Presenting symptoms of the three cases were cyanosis, heart failure, heart murmurs and alterations of heart rhythm. Diagnosis was suspected on the bases of eco and angiocardiographic studies and was finally confirmed by necropsy. Surgical exeresis of the tumor was attempted in one of the cases, but was not possible because it was too large.

Hepatic toxicity of antituberculous drugs in children.

Three cases of children who developed hepatic toxicity of different degree while on antituberculous treatment with isoniazid and rifampicin are reported. The clinical picture is presented and the pathogenesis of the hepatic damage is discussed. The pathological findings in the liver are those of a drug induced hepatitis. The combined treatment of tuberculosis in children with isoniazid and rifampicin is potentially dangerous and should be reserved for cases in which resistance to other drugs has been demonstrated.

[Idiopathic pulmonary hemosiderosis: anatomoclinical study of 2 cases]. / Hermosiderosis pulmonar idiopática: Estudio anatomoclínico de dos casos.

Two children with idiopathic pulmonary hemosiderosis are described. Both of them presented initially a clinical picture of recurring iron deficiency anemia, before pulmonary symptoms and signs made it possible to establish correct diagnosis. In one case diagnosis was considered only when an overwhelming pulmonary hemorrhage occurred, leading to the patient's death. At necropsy, areas of fresh alveolar hemorrhage and hemosiderin loaded macrophages were found, as well as moderate to severe interstitial fibrosis and hyperplastic alveolar cells. There was not disruption of the basal alveolocapillary membrane.

[Effectiveness of disodium cromoglycate, salbutamol, and ipratropium bromide in the inhibition of exercise-induced bronchospasm]. / Efectividad del cromoglicato disódico, salbutamol y bromuro de ipratropio en la inhibición de broncospasmo inducido por ejercicio.

Forty-nine asymptomatic asthmatic children who showed exercise induced bronchospasm (EIB), received in a randomized double-blind fashion one of the four following drugs administered through nebulizer and facial mask: salbutamol 4 mg (13 patients), disodium chromoglycate 20 mg (12 patients), ipratroprium bromide 0.4 mg (12 patients), placebo (12 patients). They performed exercise fifteen minutes after receiving the drugs and spirometries were done 0, 5, 10, 15 and 20 minutes after the end of the exercise. Bronchodilation was noticed 15 minutes after the administration of salbutamol and ipratroprium bromide but not after cromoglycate or placebo. No patient receiving either salbutamol or cromoglycate had EIB whereas it occurred in 50% of those receiving ipratroprium bromide and 91.6% of those receiving placebo.

[Preventing the recurrence of febrile seizures: intermittent prevention with rectal diazepam compared with continuous treatment with sodium valproate]. / Prevención de la recurrencia de crisis febriles: profilaxis intermitente con diacepam rectal comparada con tratamiento continuo con valproato sódico.

Sixty nine children suffering from a first febrile seizure without evidence of neurologic disorder or associated risk factors were randomly assigned to one of three groups: no treatment; intermittent rectal diazepam; or continuous oral sodium valproate. All patients were followed for two years. Periodical controls were performed every three months in order to record febrile episodes, recurrent seizures, and treatment side affects. Rate of recurrent febrile seizures was 16% in control group, and 5.5% in diazepam group. Sodium valproate group showed no recurrences in the follow-up period. The low relapsing rate in control group suggests that prophylaxis should not be established even if it is requested by certain parental attitudes.

[Congenital pulmonary lymphangiectasis. Report of four cases (author's transl)]. / Linfangiectasia pulmonar congénita. A propósito de cuatro observaciones.

Four cases of congenital pulmonary lymphangiectasis were observed during a five year period. This represents an incidence of 1.11 per 10,000 cases among alive newborns and of 53 per 10,000 cases among pediatric necropsias performed during the same period. One case was observed in the clinical context of a generalized hemangiolymphangiomatosis, another was associated to tetralogy of Fallot and the remaining two cases were associated to obstruction of pulmonary venous return. Although one of the pathogenic theories generally accepted in the formation of pulmonary lymphangiectasis points to the presence of either hypertension or obstruction of pulmonary venous drainage, it is possible that such situation is only circumstantial. Among 40 personal cases of obstruction of pulmonary venous return proved anatomically, only in the two cases presented were pulmonary lymphangiectasis demonstrated. The presence of dysplastic elements in pulmonary tissue in cases of lymphangiectasis suggests that a more possible mechanism is a primary defect in the development of pulmonary lymphatics.

Serum levels of alpha 1-antitrypsin and Pi types in children with bronchiolitis.

Alpha 1-antitrypsin levels were determined at the beginning of the disease and after clinical recovery in a group of 51 infants with bronchiolitis, and the results were compared to those obtained in 24 normal infants and in 15 infants with viral bronchopneumonia. Distribution of Pi types in the patients with bronchiolitis was also compared to that observed in a control population of 170 blood donors of the same ethnic background. Both serum levels of alpha 1-antitrypsin and prevalence of non-M phenotypes were not statistically different from the values found in the control groups, thus not supporting the hypothesis that a deficiency of alpha 1-antitrypsin plays a role in the pathogenesis of bronchiolitis. A non explained finding was the lack of elevation of serum level of alpha 1-antitrypsin during the acute phase of the bronchiolitis process, a fact present in the group of patients with bronchopneumonia.

[HLA antigens in infants with bronchiolitis]. / Antígenos HLA en lactantes con bronquiolitis.

The frequency distribution of HLA antigen in 100 infants with bronchiolitis is compared to a control population of 100 healthy blood donors. No differences were found in the frequency distribution of both A and B antigens, but B 7 antigen was more frequently present in patients with bronchiolitis and increased serum IgE (47% VS 17% in the control group with normal serum IgE). Serum IgE was increased in 27% of the patients with bronchiolitis. The incidence of recurrent respiratory episodes was 62% in infants carrying the B 7 antigen whereas it was only of 14,5% in the whole series (pc less than 0,05). All infants with increased serum levels of IgE and recurrent respiratory episodes had the B 7 antigen. We believe that the presence of IgE and recurrent respiratory episodes had the B 7 antigen. We believe that the presence of B 7 antigen influence the clinical course of bronchiolitis in the sense that a high percent will present with recurrent respiratory episodes and increased levels of serum IgE.

[Aberrant left pulmonary artery (author's transl)]. / Arteria pulmonar izquierda aberrante. Presentación de dos casos y revisión de la literatura.

Two cases of aberrant left pulmonary artery are described. One of them died on the third day of life and had esophageal atresia and Fallot tetralogy as associated anomalies. Outstanding symptoms of this anomaly were bouts of respiratory difficulty with espiratory wheezing. During these episodes radiographic findings were right or bilateral lung hyperaireation and middle lobe atelectasis. Upper respiratory infections usually preceded these bouts of respiratory difficulty. Diagnosis was established by the presence of a notch on the anterior wall of the esophagus, diminished pulmonary perfusion of the left lung as shown by pulmonary gammagraphy and characteristic findings in pulmonary arteriography. During the last 12 months the first case, now aged three years, has had a spontaneous regression of symptoms.

Juvenile cirrhosis and membranous glomerulonephritis in a child with alpha1-antitrypsin deficiency PiSZ.

An infant with alpha1-antitrypsin (alpha1-AT) deficiency PiSZ presented with liver cirrhosis and showed clinical and laboratory evidence of renal disease when hepatic decompensation developed, shortly before death at 12 months of age. Low serum levels of alpha1-AT were only demonstrated late in the disease. SZ phenotype was proved by starch gel electrophoresis. Post-mortem pathological studies revealed severe hepatic cirrhosis with intracytoplasmic inclusion of alpha1-AT and membranous glomerulonephritis with deposits of complement and immunoglobulins but without the presence of alpha1-AT. The present case suggests the importance of studying Pi phenotypes and serum levels of alpha1-AT in all cases of idiopathic cirrhosis or renal disease in infancy.

[Jaundice associated with congenital hypertrophic pyloric stenosis (author's transl)]. / Ictericia asociada a estenosis hipertróifica de píloro

The clinical and biological findings in six infants with congenital hypertrophic pyloric stenosis with associated jaundice are described. Pathogenesis of this association is not known but current hypothesis are based on either a decrease in the activity of hepatic glucuronyl transferase or an increase in the activity of intestinal glucuronidase. Correction of dehydration and alkalosis does not modify the hyperbilirubinemia which only disappears after pyloromiotomy.

[Nephrotic syndrome associated with congenital syphilis (author's transl)]. / Síndrome nefrótico en el curso de la sífilis congénita. Presentación de una observación y consideraciones etiopatogénicas

Clinical and renal morphologic studies are reported in a 3 1/2 month old infant with congenital syphilis and nephrotic syndrome. Renal lesions were consistent with membranous proliferative glomerulonephritis, and the presence of glomerular deposits of IgM, C3, and of less intensity of IgE and fibrin, were demonstrated by means of immunofluorescence. These findings identify the renal lesion as an immune glomerulopathy. A therapeutic course of penicillin resulted in resolution of clinical manifestations without any evidence of persistent renal damage.

[Incidence, clinical, forms and complications of meningococcal infections (author's transl)]. / Incidencia, formas clínicas, complicaciones y secuelas de la infección meningocócica.

Eighty four cases of meningococcal infections are reviewed. Fifty seven cases presented themselfs as meningococcal meningitis, twelve cases as sepsis with moderate hypotension and 15 cases were sepsis with septic shock. A brief course of the disease, shock, echymosis, absence of meningeal signs, leucopenia and intravascular coagulation were findings more frequent in the group of patients with hiperacute sepsis, whereas other signs as fever, headaches, vomiting and petechiae were present with equal frequency in the three groups. N. meningitis was isolated in 73% of the cases. Shock (18.85%) and intravascular coagulation (12%) were the complications more frequently found, followed by convulsions (4.81%), arthritis (4.81%), skin necrosis (4.81%), subdural efusion (3.57%), cerebral palsy (3.40%), thrombophlebitis (1.20%), recurrence (1.20%), inapropiate antidiuretic hormone secretion (1.20%) and subaracnoideal hemorrage (1.20%). The overall mortality was 10.70% and 60% of the patients which initially presented with shock and intravascular coagulation died. Autopsy findings included wide spred hemorragic lesions and intravascular thrombi in skin, mucous membranes and viscera. Adrenal hemorrhage was present in five of the six cases studied.

A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia.

UNLABELLED: We tested the ability of two L-type calcium channel blockers (nifedipine and nimodipine) and the N-methyl D-aspartate natural antagonist magnesium to decrease morphine requirements and pain in the postoperative period in 92 patients undergoing elective colorectal surgery. In a randomized, double-blinded study, patients were assigned to one of four groups. The control group received placebo. The nifedipine group received 60 mg of oral nifedipine. The magnesium group received an initial dose of 30 mg/kg followed by 10 mg x kg(-1) x h(-1) of magnesium sulfate over 20 h. The nimodipine group received 30 microg x kg(-1) x h(-1) of nimodipine over 20 h. Postoperative morphine consumption was assessed for 48 h. Pain at rest and pain on movement were assessed up to the fifth day postsurgery. There were no differences among groups in postoperative morphine consumption at 12 and 24 h. The nifedipine group consumed more morphine than the control and nimodipine groups during 24-48 h. Pain at rest scores were higher at 16 and 24 h in the nifedipine group than in the other three groups. Pain on movement scores were lower at 72 h in the nimodipine group than in the control and nifedipine groups. In conclusion, the perioperative application of oral nifedipine, IV nimodipine, or IV magnesium sulfate failed to decrease postoperative morphine requirements after colorectal surgery. IMPLICATIONS: The increase of intracellular calcium plays a key role in spinal transmission of pain and in the establishment of central sensitization. We examined the effects of nifedipine, nimodipine, and magnesium sulfate in postoperative analgesia after colorectal surgery. We found no differences in morphine consumption with the administration of each drug alone.

Patients with poor preoperative ejection fraction have a higher plasma response of adrenomedullin in response to open heart surgery.

BACKGROUND: Adrenomedullin (AM) is a potent vasodilator peptide. Plasma AM levels are increased in heart diseases and in sepsis. Heart surgery under cardiopulmonary bypass (CPB) induces a systemic inflammatory response. METHODS: We measured plasma AM, cAMP (the second messenger of AM), C-reactive protein (CRP) and haemodynamic parameters in 29 patients undergoing elective open heart surgery, before, during and after anaesthesia and CPB as well as on the first morning after surgery. RESULTS: Basal AM levels were higher than normal and correlated with systolic pulmonary pressure and pulmonary capillary pressure, but not with other haemodynamic parameters. AM increased during CPB and remained elevated 24 h after the start of surgery. Plasma cAMP increased only at the end of CPB. CRP was increased only in the last sample. At the end of CPB and at the end of surgery AM levels were higher in patients with basal ejection fraction<40% compared with those with ejection fraction >60% [456+/-386 vs 252+/-343 (P<0.03) and 832+/-781 vs 391+/-356 pg/ml (P<0.05), respectively]. CONCLUSION: We conclude that AM, as inflammation-related cytokines, increases during and after CPB, that cAMP response is unrelated to AM and that AM response is higher in those patients with worse basal ejection fraction.

[Etiology of acute respiratory infection in hospitalized children (author's transl)]. / Etiología de infecciones respiratorias agudas en iniños hospitalizados

Incidence of respiratory tract infection represents 23% of the total number of admissions between 1-24 months of age, during a period of 18 months. The diagnosis were: bronchiolities, 143 cases; bronchopneumonia, 134 cases; tracheobronchitis, 50 cases; laryngitis, four cases, and bacterial pneumonia, 61 cases. Monthly incidence was maximal in December of each year. From the total group, 144 cases were included in the present study to determine etiology of the infection. In 19% of the cases a serological diagnosis was posible. The adenovirus group was the most frequently found, followed by mycoplasma pneumoniae, parainfluenza 2, RS virus and M. parotiditis. RS virus was associated with a clinical picture of bronchopneumonia, mycoplasma pneumoniae with one of bronchiolitis and adenovirus was indistinctly associated with features either bronchopneumonia or bronchiolitis. In two cases it was detected a mixed infection by two virus: influenza 2 and mycoplasma pneumoniae. In four cases a bacterial surinfection was demonstrated: in two cases with coagulase-positive staphilococus and other two with klebsiella pneumoniae.