Two-stage bone and meniscus allograft and autologous chondrocytes implant for unicompartmental osteoarthritis: midterm results.

BACKGROUND: We analyzed the clinical and radiographic evolution of patients with knee unicompartmental osteoarthritis and axis alteration and osteochondral lesions in the femoral condyle, treated with tibial plateau and meniscus allograft and cultured autologous chondrocyte implantation in the femur in two steps. PURPOSE: To analyze the clinical results with the first patients treated with this two-stage technique to avoid knee prosthesis in patients with unicompartmental osteoarthritis. MATERIAL AND METHODOLOGY: Sixteen patients, average age 56 years, were included in a cohort study. We performed an osteotomy with tibia plateau allograft, including the meniscus. In a second surgery, the chondrocyte fibrin scaffold was placed in the femur. Clinical symptoms and function were measured using KSSR and KOOS scores. Wilcoxon's test was performed to compare the results over the 2-year follow-up period. RESULTS: Mean KSSR before surgery was 35.69 (SD: 3.75) points, rising to 67 (SD: 15.42) at 3 months, 95.88 at 12 months (SD: 2.68) and 96.31 at 24 months (SD: 2.24). The KOOS before surgery was 65.14 (SD: 16.34), rising to 72.68 after 3 months (SD: 19.15), 76.68 at 12 months (SD: 18.92) and 64.28 at 24 months (SD: 11.79). Four of 5 patients returned to engaging in the activity that they had stopped practicing. Three patients experienced collapse of the tibia allograft, and they needed later a prosthesis. CONCLUSIONS: Simultaneous tibia plateau allograft and autologous chondrocyte implantation in the femur, after correction of the angular deformity, were performed, restoring the anatomy of the medial compartment and knee function in 82% of the patients 2 years after the operation. LEVEL OF EVIDENCE: IV.

Eventos adversos supuestamente atribuibles a la vacunación e inmunización asociados a la vacuna anti-COVID-19 Sputnik V en el personbal del hospital Juan P. Garrahan / Adverse events allegedly attributable to vaccination and immunization with the anti-COVID-19 Sputnik V vaccine in the staff of the Hospital Juan P. Garrahan

Introducción: Debido a la emergencia provocada por la pandemia por el virus SARS-CoV-2 se ha producido una crisis sanitaria global. Una vez disponibles las vacunas, se espera que jueguen un rol decisivo para el control de la enfermedad. Dichas vacunas fueron desarrolladas en tiempo récord por lo que es esencial monitorear su seguridad. Durante la Campaña de Vacunación contra COVID-19, todos los Eventos supuestamente atribuibles a vacunación e inmunización (ESAVI) debieron ser notificados al Ministerio de Salud de la Nación a través del Sistema Integrado de Información Sanitaria de Argentina (SIISA). Materiales y métodos: Se realizó un estudio observacional prospectivo desde el 04/01/2021 al 05/05/2021 en el personal del Hospital Garrahan. Se utilizaron dos métodos de vigilancia de ESAVI. La vigilancia pasiva incluyó las notificaciones voluntarias recibidas de forma telefónica y a través de un cuestionario publicado en intranet. La vigilancia activa se realizó sobre los primeros 947 trabajadores inmunizados, enviando el mismo cuestionario por WhatsApp. Resultados: Hasta el día 05/05/2021 fueron inmunizados 5056 agentes, 4865 con las dos dosis. Se notificaron 473 ESAVI. De ellos, 304 correspondían a la primera dosis y 169 a la segunda. La cantidad de notificaciones según su origen fue de 136 para la vigilancia pasiva, y 333 para la vigilancia activa. Se registraron 5 ESAVI graves; tres anafilaxias, un escotoma secundario a la hipertermia generada por la vacuna y una reacción alérgica grave. Los síntomas locales más frecuentes fueron: dolor, enrojecimiento, hinchazón e induración. Los síntomas sistémicos más frecuentes fueron: fiebre, febrícula, astenia, cefalea, mialgia, artralgia y síntomas gastrointestinales. Como tratamiento en la mayoría de los casos se utilizó paracetamol. Discusión: El presente trabajo logró recolectar un número significativo de notificaciones, brindando información útil al tratarse de una vacuna recientemente aprobada en nuestro país y el mundo. (AU)

Introduction: Due to the SARS-CoV-2 pandemic emergency, a global health crisis has occurred. Once vaccines become available, they are expected to play a decisive role in controlling the disease. These vaccines were developed in record time, and therefore it is essential to monitor their safety. During the COVID-19 Vaccination Campaign, all Events Suspected to be Attributable to Vaccination and Immunization (ESAVI) had to be notified to the National Ministry of Health through the Integrated Health Information System of Argentina (SIISA). Material and methods: A prospective observational study was conducted from 04/01/2021 to 05/05/2021 in the staff of Garrahan Hospital. Two methods of ESAVI surveillance were used. Passive surveillance included voluntary notifications received by telephone and through a questionnaire posted on intranet. Active surveillance was conducted on the first 947 immunized workers, sending the same questionnaire by WhatsApp. Results: Up to 05/05/2021, 5056 workers were immunized, of whom 4865 with two doses. A total of 473 ESAVI were reported. Of these, 304 corresponded to the first dose and 169 to the second. The number of notifications was 136 for passive surveillance and 333 for active surveillance. Five severe ESAVIs were recorded; three anaphylaxis, one scotoma secondary to vaccine-generated hyperthermia, and one severe allergic reaction. The most frequent local symptoms were: pain, redness, swelling, and induration. The most frequent systemic symptoms were: mild fever or fever, asthenia, headache, myalgia, arthralgia, and gastrointestinal symptoms. Paracetamol was used as treatment in most cases. Discussion: In the present study a significant number of notifications was collected, providing useful information on a vaccine recently approved in our country and in the world (AU)

Augmented Reality Guided Laparoscopic Surgery of the Uterus.

A major research area in Computer Assisted Intervention (CAI) is to aid laparoscopic surgery teams with Augmented Reality (AR) guidance. This involves registering data from other modalities such as MR and fusing it with the laparoscopic video in real-time, to reveal the location of hidden critical structures. We present the first system for AR guided laparoscopic surgery of the uterus. This works with pre-operative MR or CT data and monocular laparoscopes, without requiring any additional interventional hardware such as optical trackers. We present novel and robust solutions to two main sub-problems: the initial registration, which is solved using a short exploratory video, and update registration, which is solved with real-time tracking-by-detection. These problems are challenging for the uterus because it is a weakly-textured, highly mobile organ that moves independently of surrounding structures. In the broader context, our system is the first that has successfully performed markerless real-time registration and AR of a mobile human organ with monocular laparoscopes in the OR.

Prevalencia de fracturas de cadera, fémur y rodilla en la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes" del Instituto Mexicano del Seguro Social / Prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social

Antecedentes: Las fracturas de la extremidad inferior ocurren más frecuentemente en los pacientes de edad avanzada con osteopenia después de una caída de baja energía y/o en los pacientes más jóvenes involucrados en traumatismos de alta energía. En la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes" se desconoce la prevalencia de fracturas de cadera, fémur y rodilla. Material y métodos: Diseño transversal, descriptivo y retrospectivo. Se revisaron los casos con fracturas de la extremidad inferior tratados durante el 01 de enero del 2012 al 31 de diciembre de 2013 en el Servicio de Cirugía de Cadera, Fémur y Rodilla de la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes". Resultados: La mayoría de los pacientes (52.2%) fueron del sexo femenino, siendo 64.1% de los pacientes mayor de 60 años de edad. La distribución de las fracturas de acuerdo al segmento afectado: 73.4% (n = 1,327) correspondieron a fracturas de fémur, 13.5% (n = 244) a fracturas de la meseta tibial y 13.2% (n = 238) fracturas de patela. En 66.8% (n = 1,209) de los pacientes tuvieron una estancia intrahospitalaria prolongada (mayor a 10 días). De acuerdo con la localización anatómica ósea más frecuente, las fracturas transtrocantéricas (49.1%) fueron las más frecuentes, seguidas por las fracturas de patela (13.2%) y las diafisarias del fémur (12.7%). Conclusiones: La prevalencia de las fracturas de la extremidad inferior en nuestro hospital corresponde con lo reportado a nivel internacional.

Background: Lower limb fractures are more frequent among older patients with osteopenia after a low energy fall and/or among young patients who sustain a high energy trauma. The prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes" is unknown. Material and methods: Cross-sectional study, descriptive and retrospective design. Cases with low extremity fractures treated from January 1st, 2012 to December 31st, 2013 at the Hip, Femur and Knee Service, High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", were reviewed. Results: Most patients (52.2%) were females; 64.1% of patients were over 60 years of age. Fracture distribution according to the segment involved was as follows: 73.4% (n = 1,327) were femur fractures, 13.5% (n = 244) tibial plateau fractures, and 13.2% (n = 238) patellar fractures. 66.8% (n = 1,209) of patients had a long hospital stay (more than 10 days). According to the anatomical location of fractures, transtrochanteric fractures (49.1%) were the most frequent ones, followed by patellar fractures (13.2%), and femur shaft fractures (12.7%). Conclusions: The prevalence of lower limb fractures at our hospital corresponds to what has been reported internationally.

[Prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social]. / Prevalencia de fracturas de cadera, fémur y rodilla en la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes" del Instituto Mexicano del Seguro Social.

BACKGROUND: Lower limb fractures are more frequent among older patients with osteopenia after a low energy fall and/or among young patients who sustain a high energy trauma. The prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes" is unknown. MATERIAL AND METHODS: Cross-sectional study, descriptive and retrospective design. Cases with low extremity fractures treated from January 1st, 2012 to December 31st, 2013 at the Hip, Femur and Knee Service, High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", were reviewed. RESULTS: Most patients (52.2%) were females; 64.1% of patients were over 60 years of age. Fracture distribution according to the segment involved was as follows: 73.4% (n = 1,327) were femur fractures, 13.5% (n = 244) tibial plateau fractures, and 13.2% (n = 238) patellar fractures. 66.8% (n = 1,209) of patients had a long hospital stay (more than 10 days). According to the anatomical location of fractures, transtrochanteric fractures (49.1%) were the most frequent ones, followed by patellar fractures (13.2%), and femur shaft fractures (12.7%). CONCLUSIONS: The prevalence of lower limb fractures at our hospital corresponds to what has been reported internationally.

Effects of an enriched housing environment on sensory aspects and fatty-acid composition of the longissimus muscle of light-weight finished lambs.

We analysed the effect of enriched housing on the sensory meat quality and fatty acid composition of longissimus muscle in 60 entire Rasa Aragonesa lambs, housed indoors for 5 weeks in six pens (10 lambs/pen, 0.95 m(2)/lamb, initial weight 17.13±0.18 kg and carcass mean 12.23±0.23 kg); three control pens (barren) and three enriched pens (straw, platform with ramps and a small ramp). The final weight, carcass weight, fatness scores and cooking losses of meat from enriched lambs (EG) were higher and pH 24 was lower (P ≤ 0.05). The EG lambs had more C18:0 and total SFA (P ≤ 0.05). Lamb odour and grass odour were more intense in EG (P ≤ 0.05). Overall liking was higher for EG (P ≤ 0.05) and associated with tenderness (P ≤ 0.0001). The results suggest that environmental enrichment can have effects on fatty acid composition and sensory meat quality.

[Comparison of patellar dislocation recurrence in patients ages 9 to 16 years treated surgically with the green technique versus an arthroscopic approach]. / Comparación de la recurrencia de la luxación de patela en pacientes de 9 a 16 años operados con técnica tipo Green contra vía artroscópica.

OBJECTIVE: To report the patellar dislocation recurrence in patients ages 9 to 16 years treated surgically with the Green technique or an arthroscopic approach. MATERIAL AND METHODS: A prospective, longitudinal study was conducted with patients ages 9 to 16 years who presented at the pediatric orthopedics and arthroscopy service at IMSS "Lomas Verdes" UMAE Orthopedics and Traumatology Hospital with a diagnosis of patellar dislocation from January 1st 2003 to December 31st 2006. The patellar dislocation recurrences were recorded. RESULTS: Twenty patients and 24 knees were included; 13 females and 7 males; mean age was 14.3 years +/- 1.75. The dislocations prior to surgical treatment occurred at a mean of 5.5 +/- 2.57 dislocation events, with a range of 2 to 10 events. As regards the side involved, 40% had involvement of the left side, 40% of the right side, with 8 patients each, and 20% were bilateral dislocations. No significant differences were found in the clinical course of the patients treated with the Green technique compared with the arthroscopic surgery group (p = 0.371). CONCLUSIONS: The number of dislocation recurrences after the surgical procedure was not related with the age, gender, number of prior dislocations or surgical technique. No significant difference was found between both groups.

Haemophilic arthropathy: the usefulness of intra-articular oxytetracycline (synoviorthesis) in the treatment of chronic synovitis in children.

Synoviorthesis is already widely used in the treatment of chronic haemophilic synovitis. The aim of this study was evaluate the effectiveness of oxytetracicline synoviorthesis on the frequency of haemarthrosis in haemophilic children with chronic synovitis and its impact on joint function. Between January 2001 and October 2006, we performed 34 synoviorthesis in 28 paediatric patients (6-16 years old) with diagnosis of haemophilic arthropathy stage I-II. At each joint were administered five doses of oxytetracycline for five consecutive weeks at doses of 100 mg in elbow and ankle and 250 mg in the knee. The frequency of haemarthrosis and range of joint mobility were evaluated before and after of treatment. The results were analysed with Student t-test and descriptive statistics. Thirty-four joints were treated, including 20 knees (58.8%), eight elbows (23.5%) and six ankles (17.6%). Median follow-up was 46.3 months (range 12-71 months). The frequency of haemarthrosis was recorded before treatment 47.3 year(-1) (range 12-96, P < 0.0001) and decreased to 3.5 year(-1) (range 0-15, P = 0.0119) after treatment. The range of joint motion in flexion-extension before treatment was 84.9°, while after this was 97.5° (P = 0.0119). The synoviorthesis with oxytetracycline has shown a favourable effect in the treatment of chronic haemophilic synovitis in reducing the frequency of haemarthrosis and improvement was observed consistently in the range of motion.

[Pre- and postoperative functional status of patients subjected to anterior cruciate ligament reconstruction associated with knee dislocation]. / Estado funcional pre y postoperado de pacientes con reconstrucción de ligamento cruzado anterior asociado a luxación de rodilla.

INTRODUCTION: The injury of the cruciate ligaments secondary to knee dislocation is caused by high energy trauma; its incidence rate is less than 0.02%; there are multiple treatments, with surgery being the most common one. OBJECTIVE: To determine the functional characteristics of patients who underwent cruciate ligament plasty and sustained knee dislocation. MATERIAL AND METHODS: An observational, prospective, cross-sectional study was conducted including all adult patients with a diagnosis of cruciate ligament injury resulting from knee dislocation who were surgically treated from January 2006 to December 2007. Two knee functional assessment scales were used. RESULTS: A total of 16 patients were included, 12 males and 4 females; mean age was 32.1 years. The Knee Society Clinical Rating Scale had a positive correlation with the Lysholm Knee Scoring Scale (r = 0.836) with p = 0.001. DISCUSSION: The functional results of patients treated surgically are diverse. This study was not conducted as a controlled clinical trial due to the absence of randomization, which was not possible due to the infrequency of the condition. CONCLUSIONS: It will be necessary to confirm the results after a longer follow-up and in a comparative, double-blind study of patients undergoing surgery.

Causa de pérdida de dientes en la población adulta de 35-44 y de 65-74 años de edad, de la Región Metropolitana / Cause of teeth lossing in the adult population of 35-44 and of 65-74 years old of the Region Metropolitana

The aim of this study was to establish the principal cause of teeth lossing in the adult community aged between 35-44 and 65-74 in Santiago, Metropolitana Región. The clinical histories of the patients included in an investigation carried out in 8 communities of the Metropolitan Región, and in a private medical-dental center in the Tabancura and Ñuñoa communities were cheeked. The sample was of 1.096 individuals, with a total of 5.207 lossed teeth. Results: the 77,17 por ciento of the total extracted teeth were lost because of dental decay (p

[The treatment and prevention of acute diarrheal disease]. / El tratamiento y prevención de la enfermedad diarreica aguda.

Diarrheal diseases are the main cause of infant mortality in children under five year of age in the Third World. In order to diminish the mortality and morbidity rate, the World Health Organization developed the Diarrhoeal Diseases Control Programme (DDCP). The DDCP recommends two actions: to prevent diarrheal diseases and treatment of dehydration, the main cause of death in diarrheal diseases. Plan A is devoted to prevent dehydration; Plan B to treat orally dehydration; and Plan C to treat severe dehydration by means of rapid intravenous therapy. These plans were devised by health workers skill in the management of adults presenting Asiatic Cholerae. Thereafter the same method was used in non cholerae diarrhea, and finally in infants and children of all ages. The method has proven to be useful for treating all dehydration complications. The pediatric textbooks recommend the use of oral rehydration therapy (ORT) but do not support it very strongly. Plan C is not known by these authors, who recommend the old fashioned method used in the 70's. Here in I present the most advanced rehydration methods.

Rice-based oral electrolyte solutions for the management of infantile diarrhea.

BACKGROUND: In infants the treatment of acute diarrhea with glucose-based solutions results in rehydration but does not reduce the severity of diarrhea. Oral rehydration with solutions based on rice powder may reduce stool output as well as restore fluid volume. METHODS: We designed a prospective, randomized, double-blind study to evaluate the efficacy of two rice-based rehydration solutions and a conventional glucose-based solution. Solution A contained only rice-syrup solids, solution B contained rice-syrup solids and casein hydrolysate, and solution C, the glucose-based solution, served as control. The study subjects were 86 mildly to moderately dehydrated infant boys, 3 to 18 months old, who were admitted to a children's hospital with acute diarrhea. We measured fluid intake, fecal and urine output, and absorption and retention of fluid, sodium, and potassium at intervals for 48 hours in all 86 infants. RESULTS: The mean (+/- SE) fecal output was significantly lower in the infants given solution A (group A infants) than in the infants given solution C (group C) (29 +/- 4 vs. 46 +/- 7 ml per kilogram of body weight, P less than 0.05) during the first six hours of therapy. The infants in group A also had greater fluid absorption (221 +/- 16 vs. 167 +/- 9 ml per kilogram, P less than 0.05) over the entire 48 hours of therapy and greater potassium absorption (1.6 +/- 0.2 vs. 0.6 +/- 0.1 mmol per kilogram, P less than 0.05) during the first six hours than the infants in group C. Solution B offered no advantages over solution A. CONCLUSIONS: Solutions containing rice-syrup solids were effective in the rehydration of infants with acute diarrhea. They decreased stool output and promoted greater absorption and retention of fluid and electrolytes than did a glucose-based solution.

[The maternal-neonatal characteristics of intrauterine growth retardation in a term pregnancy based on a national curve of intrauterine growth]. / Características materno-neonatales del retardo de crecimiento intrauterino en la gestación de término según curva nacional de crecimiento intrauterino.

Using a national curve of fetal growth development, clinical and laboratory characteristics of 100 term neonates small for dates and 130 term adequate for gestational age newborns are studied. A 91% of the small for dates were classified by the ponderal index as having symmetrical growth retardation. At the same time in the 230 mothers we look for clinical features that have been mentioned to produce intrauterine growth retardation. Results showed marked differences (with statistic significance) between both groups of women in relation to: nutritional factors, maternal height, labor activity and presence of oligoamnios. The newborns of both groups didn't show differences, with exception of congenital malformation. The incidence of the classical morbidity of small for dates (asphyxia, hypoglycemia, polycythemia) was no different in both groups. We believe the explanation is that the national curve is more exigent and neonates with higher weight fall under the 10th percentile. We think that in the study group a high percentage of small for dates, are constitutional small and not really growth retarded. We suggest the possibility to use the 5th percentile for better sensibility.

Comparison of efficacy of a glucose/glycine/glycylglycine electrolyte solution versus the standard WHO/ORS in diarrheic dehydrated children.

It was hypothesized that a mixture of glucose and amino acids enhances sodium and water absorption and therefore diminishes the volume of oral rehydration solution, stool output, and duration of diarrhea. To investigate this hypothesis, the efficacies of two oral rehydration solutions (ORS) were compared, one containing (mmol/L): Na+ 90, K+ 20, Cl- 80, citrate 10, glucose 67, glycine 53, and glycylglycine 30, yielding an osmolality of 350 mosmol/kg H2O, and the other, the standard ORS recommended by the World Health Organization, containing the same electrolyte concentrations and only glucose 110 mmol/L, yielding 310 mosmol/kg H2O. The study group comprised 31 infants and small children for group A (receiving solution A, the glucose/glycine/glycylglycine-based ORS) and 31 patients for group B (receiving solution B, the standard WHO/ORS). There were no significant differences between the groups in age, fluid loss, or dehydration, or between the groups with respect to clinical outcome, mean time to achieve rehydration, mean percent body weight gain, and serum electrolyte composition. The only statistically significant difference was the mean time between admission and the last diarrheic stool. The glycylglycine/glycine/glucose electrolyte solution was found to be suitable for rehydration, but not to have an advantage over the standard WHO/ORS.

PIP: A study was carried out on 62 male infant children, aged 3-24 months in San Jose, Puerto Rico. The purpose of the study was to discover if a mixture of glucose and amino acids enhances sodium and water absorption, thereby diminishing the volume of oral rehydration solution, stool output and duration of diarrhea. To investigate this hypothesis, the efficacies of two oral rehydration solutions (ORT) were compared: the ORT recommended by WHO (mmol/L) Na + 90, K + 20, C1- 80 Citrate 10, Glucose 110, yielding an osmolality of 310 (mosmol/kg H20) and one containing (mmol/L): Na+ 90, K+ 20, C1-80, Citrate 10, Glucose 67, Glycine 53, Glycylglycine 30, and yielding an osmolality of 350 (mosmol/kg H2)). Results are as follows: the infants were divided into two groups - A and B - with each consisting of 31 males per group; group A received the glycine based solution while group B received the WHO/ORS. There was no significant difference in: the mean age of the patients, mean time and mean number of vomiting, duration of diarrhea, number of stool motions, and duration of fever before admission between the two groups. The glycylglycine/glycine/ glucose electrolyte solution was found to be suitable for rehydration, but is not superior to the standard WHO/ORS. The glycine solution resulted in shortening the duration of diarrheal illness, but failed to decrease the ingested amount of ORS as well as the stool output volume.

Hypernatremic diarrheal dehydration treated with oral glucose-electrolyte solution containing 90 or 75 mEq/L of sodium.

Of 33 infants with hypernatremic dehydration (serum Na+ of greater than or equal to 150 mEq/L) 7 were excluded, 6 because severe alteration of the level of consciousness or shock precluded oral rehydration and 1 because he was given glucose-electrolyte solution plus water. We studied the remaining 27 infants. Twenty (group A) were treated with the World Health Organization-recommended oral rehydration solution (90 mEq/L Na+) and seven (group B) were treated with Pedialyte-RS (Abbott Laboratories Ltd.; 75 mEq/L Na+). The rehydrating solutions were administered in a volume equivalent to twice the clinically estimated fluid deficit. Initial serum sodium was 156.7 +/- 0.9 mEq/L for group A and 155.8 +/- 1.8 mEq/L for group B (mean +/- SEM). The mean time to achieve rehydration was 14.3 and 16.6 h for groups A and B, respectively. Twenty-four hours after commencing oral rehydration, serum Na+ had decreased to 144.8 +/- 1.8 mEq/L for group A and 144.5 +/- 0.9 mEq/L for group B. In two patients in group A, the serum Na+, which, had not decreased to less than 150 mEq/L at 24 h, did so at 48 h. Only in one case (group A) did the serum Na+ increase. This patient had high stool output and failed to become rehydrated after 24 h of unsuccessful oral rehydration. None of the patients had seizures or persistent CNS dysfunction. We conclude that the slow administration of oral rehydration solutions containing either 90 or 75 mEq/L Na+ is a safe and effective treatment of hypernatremic dehydration.

Comparison of glucose/electrolyte and glucose/glycine/electrolyte oral rehydration solutions in hospitalized children with diarrhea in Costa Rica.

The experience of Nalin et al. and Patra et al. with a "super oral rehydration solution (ORS)" containing glucose plus glycine to enhance the intestinal absorption of sodium and water prompted us to investigate a similar ORS containing the standard World Health Organization (WHO/ORS) plus either 55 or 110 mmol/L glycine in infants and small children with noncholera diarrhea. We did not find a statistically significant difference between the glycine-fortified ORS and the standard WHO/ORS with respect to the clinical outcome and composition of serum electrolytes.

PIP: Oral rehydration solutions containing the WHO recommended mixture alone, or with 111 mmol/L glycine or 55 mmol/L glycine were compared for treatment of 30 male children aged 1-24 months with clinical diarrheal dehydration in the emergency room of the National Children's Hospital, San Jose, Costa Rica. ORS volume was estimated by doubling the degree of dehydration judged clinically, offered by teaspoons over 4 hours. Children that could not tolerate oral solution were given ORS by nasogastric tube. Those with hypokalemia 3 mmol/L were given a solution containing 20 mmol/L K+ or iv fluid. The time to rehydration averaged 9.45 hours with the WHO solution, 10.2 hours with the low glycine ORS and 8.95 with the high glycine ORS (n.s.). Percent body weight gain did not differ significantly. The average stool weight and urine excretion were lower in the high glycine group, not significantly. 3 children developed mild hypernatremia, but normalized without additional treatment. Thus, glycine-fortified ORS made no significant difference in clinical outcome or serum electrolytes in this series.

Oral rehydration in infants in developing countries.

Diarrhoeal diseases are the major cause of infant mortality in developing countries. Dehydration is the most common complication of diarrhoea, and severe dehydration causes up to 80% of diarrhoeal fatalities. For more than 100 years, physicians focused the treatment of diarrhoeal diseases on the symptom diarrhoea, and there were many 'antidiarrhoeal' drugs, such as water adsorbents (kaolin and pectin) and antiperistaltics (opium, paregoric elixir, diphenoxylate hydrochloride with atropine sulphate and loperamide). This approach focused on a non-dangerous symptom and diverted attention from the real killer, dehydration. A few decades ago, only severely dehydrated patients were treated by intravenous therapy. This treatment was prescribed by a group of professional health workers, administered intravenously by skilled nurses, and reserved for the few patients resident near health facilities. Oral rehydration therapy (ORT), developed 20 years ago, has several advantages over intravenous therapy; it can be administered at home, at health clinics or in modern hospitals, by parents or by nurses or physicians. Most serum disturbances in dehydrated neonates, infants, children, adults and the elderly are resolved by this treatment.