[Mandibular distraction osteogenesis in patients with craniofacial malformation]. / Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales.

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy may be necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, minimum.

[Criss-cross heart: anesthetic considerations for total cavopulmonary shunt (Fontan procedure)]. / Corazón en criss-cross. Consideraciones anestésicas para derivación cavopulmonar total (Fontan).

We report the anesthetic technique used for interatrial septal defect a 2-year-old girl weighing 11 Kg who presented with crossed atrioventricular connection (criss-cross heart), transposition of the great vessels, interatrial and interventricular septal defects, and subpulmonary and pulmonary valve stenoses. The patient was proposed for total cavopulmonary anastomosis with basal arterial oxygen saturation (SapO2) at 65%. Anesthesia was induced with inhaled agents and after intubation, hyperventilation was induced to achieve an end-tidal carbon dioxide pressure around 27 mm Hg. General anesthesia was provided in combination with spinal infusion of morphine chloride (100 microg Kg(-1)) for pain control. A Fontan procedure was carried out uneventfully with cardiopulmonary bypass. Milrinone was used at the extracorporeal circuit pump outlet. The patient was transferred to the pediatric intensive care unit where she was extubated without complications 90 minutes after admission. Anesthetic management is based on maintaining adequate preloading doses by administering volume, inhaled and/or intravenous agents, or use of vasoconstrictors and adjustment of ventilator parameters to modify pulmonary or systemic vascular resistance. We were able to maintain normal arterial pressure in our patient and provide adequate preloading through hyperventilation to reduce pulmonary vascular resistance.

[Paradoxical reaction to midazolam after its use as a sedative in regional anesthesia]. / Reacción paradójica al midazolam tras su uso como sedante en anestesia regional.

We report 3 cases of paradoxical reaction to midazolam after being used for sedation during regional anesthesia. The picture was characterized by a marked aggressiveness. In one case the reaction was treated with general anesthesia, whereas in the other two patients the clinical picture was rapidly reversed by administration of flumazenil. We describe the possible causative mechanisms of this reaction as well as their treatment.

[Efficacy of EMLA cream, effect of time and place of application]. / Eficacia de la crema EMLA, influencia del lugar y tiempo de aplicación.

OBJECTIVE: To evaluate the anesthetic efficacy of EMLA cream for alleviating pain associated with puncture and pressure in areas where venous catheters are normally inserted. MATERIAL AND METHODS: We performed a prospective, double blind study in 38 volunteers between 25 and 36 years of age, after obtaining informed consent. A 1.5 g dose of EMLA cream was applied to three sites on each patient: the back of the hand, the antecubital fossa and the side of the neck. Placebo cream with similar characteristics was applied to contralateral sites. Pain was evaluated on a visual analog scale (VAS, 0-10). Tactile sensitivity was assessed on a four-point scale (0 = no sensation; 1 = slight sensation; 2 = moderate, and 3 = strong). An analysis of variance study was performed to compare baseline scores to results over time, and placebo results to EMLA scores for each test site. RESULTS: The assessment of response to puncture and pressure gradually decreased over time for the sites where EMLA cream was applied, but not for the areas where placebo was applied. CONCLUSION: The efficacy of EMLA cream varies demonstrably depending on type of stimulus, site of application and time since application.

[Analysis of regional anesthetic efficacy in pediatric postop pain]. / Análisis de la eficacia analgésica de la anestesia locorregional en cirugía infantil.

A randomized, double blind study was carried out in 76 paediatric surgical patients scheduled for herniography or circumcision. Patients were randomly assigned to receive ilioinguinal and iliohipogastric nerve block (group A), penile block (group B), caudal block (group C) or metamizol intravenously (group D). Postoperative pain was evaluated by Objective pain scale at the end of surgical process and at 15, 30, 60 minutes and 6 hours after surgery. Pain free time was also recorded. There was no difference between groups regarding demographic data. We find a significatively less pain scores in the children who received regional anaesthesia. In those groups the administration of any analgesic were not necessary. No side effects were recorded. We conclude that locorregional anaesthesia techniques are safe and effective for minor surgery in children, because they are easy to carry out, comfortable for the patient, and provide a good postoperative analgesia.

Histochemical detection of monoamine oxidase and alcohol dehydrogenase activities in the Syrian hamster Harderian glands: existence of a sexual dimorphism.

Monoamine oxidase (MAO) and alcohol dehydrogenase (AD) activities were studied histochemically in the Syrian hamster Harderian gland using tryptamine as substrate and Nitroblue Tetrazolium as the final electron acceptor. No dark: light-related changes were observed. Male type I secretory cells showed an intense MAO reaction. Female type I cells exhibited a moderate MAO activity. Both male and female glands showed a moderate/intense AD-positive reaction. Male type II cells were lacking MAO and AD activities. MAO activity found in the hamster Harderian glands corresponded mainly to MAO type A since treatment with chlorgyline (0.01, 0.1 and 0.5 mM) totally inhibited it. The possible role of these two enzymes in Harderian gland indolalkylamine metabolism is discussed.

Sexual dimorphism in the cholinergic innervation of the hamster (Mesocricetus auratus) harderian glands.

We study the cholinergic innervation of the Harderian gland in male and female golden hamsters. There is a clear sexual dimorphism in the cholinergic innervation between both sexes. The Harderian gland from male animals contain much more nervous fibers with acetylcholinesterase (AChE) positive reaction than in female. The nervous fibers containing AChE activity are surrounding the acini and blood vessels.

Ultrastructural, immunocytochemical and morphometric studies of pituitary prolactin cells after chronic administration of met-enkephalin.

The effects of chronic administration of met-enkephalin (40 micrograms/day, for 20 days) on the pituitary prolactin cells of Wistar male rats were studied at the light (PAP-immunohistochemical for PRL demonstration technique) and electron microscopy levels. The D. CIRCLE (mean diameter), D. MAX (maximum diameter) and FORM PE (circular factor of form; irregularity degree) form secretory granules, as well as their percent distribution, were also evaluated. The cellular alterations were variable. Most prolactin cells showed an increase in immunohistochemical reaction. At the electron microscope level the prolactin cells showed an enlargement and swelling of the RER and Golgi apparatus. The secretory granules were bigger and more spherical in experimental than in untreated and control animals. A number of cells showed a variable number of cytoplasmic vacuoles or a large central vacuole formed from dilated RER-cisternae. The authors discuss the possible mechanism whereby met-enkephalin exerts a control on prolactin cells.

[Innervation of the ventral prostate of the rat: ultrastructural study]. / Inervación de la próstata ventral de la rata: estudio ultraestructural.

The innervation of the rat ventral prostate was studied at the ultrastructural level. The nerve fascicles, amyelinics, are found in the interstitial tissue of the gland. We have observed varicosities with synaptic vesicles in close contact with the smooth muscle and epithelial cells. Inside the nerve endings, 5 types of vesicles could be distinguished. The role of the different nerve endings is discussed.

Acetyl-cholinesterase and fluoride-resistant acid phosphatase activities in dorsal root ganglia in the rat.

Acetylcholinesterase and fluoride-resistant acid phosphatase activities were contrasted in alternative serial sections of rat dorsal root ganglia. The morphometric analysis demonstrated no correlation between cellular size and enzymatic activity. Differences with previous works in this area are discussed.

[Cholinergic innervation of the prostate in the white rat (Rattus norvegicus)]. / Inervación colinérgica de la próstata en la rata blanca (Rattus norvegicus).

We studied the cholinergic innervation of the prostate in male albino rats using a technic for demonstrating acetylcholinesterase (AChE) activity. We observed AChE-positive nerve fibers surrounding the acini and blood vessels. In the prostatic ventral lobe, a large number of AChE-reactive neurons (isolated or forming microganglia) were observed. However, no neurons were observed in the dorsal-lateral prostatic lobe. The foregoing findings suggest a different cholinergic innervation for these prostatic lobes.