Multisystem Inflammatory Syndrome in Children and Cardiac Involvement: A Quaternary Center Experience.

We prospectively analyzed clinical and laboratory characteristics associated with cardiac involvement and severe presentation in multisystem inflammatory syndrome in children. Of 146 patients, 66 (45.2%) had cardiac dysfunction and 26 (17.8%) had coronary artery abnormalities. Lower serum albumin levels, absolute lymphocyte and platelet counts, and elevated ferritin, fibrinogen, d-dimer and interleukin-6 levels were associated with cardiac dysfunction. Possible treatment complications were identified.

Pigmented neurofibroma with hypertrichosis.

BACKGROUND: Pigmented (or melanocytic) neurofibroma (PN) constitutes only 1% of cases and is considered a rare variant of neurofibroma containing melanin-producing cells. In addition, the association of PN with hypertrichosis is infrequent. CASE REPORT: We describe the case of an 8-year-old male with a neurofibromatosis type 1 (NF1) diagnosis, who presented a light brown hyperpigmented plaque, smooth and well-demarcated, and hypertrichosis on the left thigh. The skin biopsy showed characteristics of neurofibroma; however, in the deep portion of the lesion, melanin deposits positive for S100, Melan-A, and HMB45 were observed, thus establishing the diagnosis of pigmented neurofibroma. CONCLUSIONS: Although PN is a rare subtype of neurofibroma, it is considered a chronically progressive benign tumor containing melanin-producing cells. These lesions can appear alone or in association with neurofibromatosis. Since this is a tumor that can be confused with other skin lesions, biopsy analysis is essential to differentiate it from other pigmented skin tumors, such as melanocytic schwannoma, dermatofibrosarcoma protuberans, neurocristic hamartoma, or neuronevus. Surveillance is part of the treatment, and surgical resection is sometimes performed.

INTRODUCCIÓN: El neurofibroma pigmentado (NP) o melanocítico constituye solamente el 1% de los casos y se considera como una variante rara del neurofibroma que contiene células productoras de melanina. Además, la asociación de NP con hipertricosis es muy rara. CASO CLÍNICO: Se describe el caso de un paciente de sexo masculino de 8 años 2 meses de edad con diagnóstico de neurofibromatosis tipo 1 (NF1), quien presentaba en la cara anterior del muslo izquierdo una placa hiperpigmentada de color café claro, bien delimitada y de consistencia suave, e hipertricosis. La biopsia de piel presentó cambios característicos de neurofibroma; sin embargo, en la porción profunda de la lesión se observaron depósitos de melanina positivos para S100, Melan-A y HMB45, con lo que se estableció el diagnóstico de neurofibroma pigmentado. CONCLUSIONES: Aunque el NP es un subtipo raro del neurofibroma, se considera que es un tumor benigno de evolución crónica de células productoras de melanina. Estas lesiones aparecen en solitario o asociadas con neurofibromatosis. Dado que es un tumor que puede confundirse con otras lesiones cutáneas, es fundamental el análisis de la biopsia para diferenciarlo de otros tumores cutáneos pigmentados, como el schwanoma melanocítico, dermatofibrosarcoma protuberans, hamartoma neurocrístico o neuronevus. La vigilancia es parte del tratamiento y, en ocasiones, se lleva a cabo la resección quirúrgica.

Pigmented neurofibroma with hypertrichosis / Neurofibroma pigmentado con hipertricosis

Abstract Background: Pigmented (or melanocytic) neurofibroma (PN) constitutes only 1% of cases and is considered a rare variant of neurofibroma containing melanin-producing cells. In addition, the association of PN with hypertrichosis is infrequent. Case report: We describe the case of an 8-year-old male with a neurofibromatosis type 1 (NF1) diagnosis, who presented a light brown hyperpigmented plaque, smooth and well-demarcated, and hypertrichosis on the left thigh. The skin biopsy showed characteristics of neurofibroma; however, in the deep portion of the lesion, melanin deposits positive for S100, Melan-A, and HMB45 were observed, thus establishing the diagnosis of pigmented neurofibroma. Conclusions: Although PN is a rare subtype of neurofibroma, it is considered a chronically progressive benign tumor containing melanin-producing cells. These lesions can appear alone or in association with neurofibromatosis. Since this is a tumor that can be confused with other skin lesions, biopsy analysis is essential to differentiate it from other pigmented skin tumors, such as melanocytic schwannoma, dermatofibrosarcoma protuberans, neurocristic hamartoma, or neuronevus. Surveillance is part of the treatment, and surgical resection is sometimes performed.

Resumen Introducción: El neurofibroma pigmentado (NP) o melanocítico constituye solamente el 1% de los casos y se considera como una variante rara del neurofibroma que contiene células productoras de melanina. Además, la asociación de NP con hipertricosis es muy rara. Caso clínico: Se describe el caso de un paciente de sexo masculino de 8 años 2 meses de edad con diagnóstico de neurofibromatosis tipo 1 (NF1), quien presentaba en la cara anterior del muslo izquierdo una placa hiperpigmentada de color café claro, bien delimitada y de consistencia suave, e hipertricosis. La biopsia de piel presentó cambios característicos de neurofibroma; sin embargo, en la porción profunda de la lesión se observaron depósitos de melanina positivos para S100, Melan-A y HMB45, con lo que se estableció el diagnóstico de neurofibroma pigmentado. Conclusiones: Aunque el NP es un subtipo raro del neurofibroma, se considera que es un tumor benigno de evolución crónica de células productoras de melanina. Estas lesiones aparecen en solitario o asociadas con neurofibromatosis. Dado que es un tumor que puede confundirse con otras lesiones cutáneas, es fundamental el análisis de la biopsia para diferenciarlo de otros tumores cutáneos pigmentados, como el schwanoma melanocítico, dermatofibrosarcoma protuberans, hamartoma neurocrístico o neuronevus. La vigilancia es parte del tratamiento y, en ocasiones, se lleva a cabo la resección quirúrgica.

Leukemia cutis and other dermatological findings in pediatric patients with acute myeloid leukemia / Leucemia cutis y otras manifestaciones dermatológicas en pacientes pediátricos con leucemia mieloide aguda

Abstract Background: Leukemia cutis (LC) is the infiltration of neoplastic leukocytes into the skin, causing skin lesions. In children, it appears more frequently in patients with acute myeloblastic leukemia (AML), particularly in subtypes with a monocytic component. Methods: We studied a retrospective cohort including all AML cases from the Hospital Infantil de México Federico Gómez between January 2009 to December 2019 and described the clinical characteristics of those who presented LC and other mucocutaneous manifestations. The information was collected from clinical records and analyzed using SPSS software (version 17). Results: We identified 54 AML cases: 53.7% were males, and 75.9% of the patients presented at least one dermatosis in the course of the disease. LC was clinically present in 14.8% of patients and was histologically confirmed in 9.2% of them; two congenital leukemia cases were identified. Among these patients, LC was more frequent in males. LC patients were younger than those without LC, the most frequent AML subtype was M2 (37.5%), and the most frequent clinical manifestations were plaques, chloromas, and gingival hyperplasia. None of the patients presented LC before AML diagnosis. Conclusions: Currently, only a few studies about LC on pediatric populations have been reported, and the existing ones have small sample sizes. We found clinical and epidemiological similarities with other populations in the studied sample.

Resumen Introducción: La leucemia cutis (LC) es la infiltración de leucocitos neoplásicos a la piel que provoca lesiones cutáneas. En la población infantil aparece con más frecuencia en pacientes con leucemia mieloblástica aguda (LMA), principalmente en los subtipos con componente monocítico. Métodos: Se estudió una cohorte retrospectiva en el Hospital Infantil de México Federico Gómez entre enero de 2009 y diciembre de 2019 para conocer las características clínicas de los pacientes con LMA que cursaron con LC y otras manifestaciones mucocutáneas. La información se recabó de los expedientes clínicos y se analizó con el programa estadístico SPSS versión 17. Resultados: Se identificaron 54 casos de LMA: el 53.7% en el sexo masculino y el 46.3% en el sexo femenino. El 75.9% de los pacientes presentaron alguna dermatosis durante el curso de su enfermedad. La LC se presentó clínicamente en el 14.8% de los pacientes y se confirmó histológicamente en el 9.2% de ellos; dos casos correspondieron a leucemia congénita. De estos pacientes, la LC fue más frecuente en el sexo masculino, los pacientes fueron más jóvenes que el grupo sin LC, el subtipo de LMA más frecuente fue el M2 (37.5%) y las principales manifestaciones clínicas fueron placas infiltradas, cloromas e hiperplasia gingival. Ninguno de los pacientes presentó LC antes del diagnóstico de LMA. Conclusiones: Hasta ahora existen pocos estudios de LC en las diferentes variedades de leucemia en la población infantil, y los existentes cuentan con un tamaño de muestra pequeño. En este estudio se reportan estadísticas descriptivas y se encuentran similitudes clínico-epidemiológicas con otras poblaciones.

Acné en el recién nacido / Acne in the newborn

Resumen El acné neonatal es una dermatosis transitoria que ocurre entre la segunda y la cuarta semanas de vida en uno de cada cinco niños. Es más frecuente en los varones, con una relación de sexo masculino-femenino de 4.5:1. Las manifestaciones clínicas incluyen comedones abiertos y cerrados que pueden progresar a lesiones inflamatorias como pápulas, pústulas eritematosas y, en casos raros, nódulos y quistes. Las zonas afectadas incluyen la frente, las mejillas, el mentón y los párpados, y en algunas ocasiones puede extenderse a la piel cabelluda, el cuello y el tronco. Ocurre por la mayor producción de andrógenos placentarios y neonatales (de origen suprarrenal en ambos sexos y de origen testicular en los varones), que provoca hipertrofia de las glándulas sebáceas y mayor producción de sebo. La mayoría de los casos son leves y autolimitados. Cuando el acné neonatal es grave y prolongado, se debe considerar la posibilidad de hiperandrogenismo, cuyas causas más frecuentes en esta edad son la hiperplasia suprarrenal congénita y los tumores, adrenales o gonadales, productores de andrógenos. El diagnóstico del acné neonatal es clínico: se debe distinguir de la pustulosis cefálica neonatal, otras dermatosis neonatales vesiculopustulares, enfermedades infecciosas y reacciones acneiformes. Habitualmente, un dermolimpiador suave y agua resultan suficientes para su manejo. Las lesiones obstructivas (comedones abiertos y cerrados) pueden requerir retinoides tópicos o ácido azelaico al 20%, y las lesiones inflamatorias, algunos antibióticos tópicos.

Abstract Neonatal acne (NA) is a transitory dermatosis that occurs between the second and fourth weeks of life in 20% of children. This condition is more frequent in males, with a male-female ratio of 4.5:1. Present primary skin lesions are open and closed comedones which can evolve into papules, erythematous pustules and, in rare cases, nodules and cysts. NA topography includes the forehead, cheeks, chin, and eyelids, but occasionally it spreads to the scalp, neck, and trunk. NA occurs due to an elevated production of placental and neonatal androgens (of adrenal origin in both sexes and of testicular origin in males) which cause enlargement of the sebaceous glands and increases the production of sebum. Most cases are mild and transient, but if NA is severe and long-lasting, clinical and paraclinical examination will be necessary to find congenital adrenal hyperplasia or a virilizing tumor of adrenal or gonadal origin. The diagnosis of NA is clinical; its main differential Ádiagnoses are neonatal cephalic pustulosis, other neonatal vesiculopustular dermatoses, infectious diseases, and acneiform reactions. The resolution of NA is spontaneous. In most cases, the use of a mild dermal cleanser and water will be sufficient. For comedogenic lesions (open and closed comedones), topical retinoids or 20% azelaic acid may be used, as well as some topical antibiotics for inflammatory lesions.

[Acne in the newborn.] / Acné en el recién nacido

Neonatal acne (NA) is a transitory dermatosis that occurs between the second and fourth weeks of life in 20% of children. This condition is more frequent in males, with a male-female ratio of 4.5:1. Present primary skin lesions are open and closed comedones which can evolve into papules, erythematous pustules and, in rare cases, nodules and cysts. NA topography includes the forehead, cheeks, chin, and eyelids, but occasionally it spreads to the scalp, neck, and trunk. NA occurs due to an elevated production of placental and neonatal androgens (of adrenal origin in both sexes and of testicular origin in males) which cause enlargement of the sebaceous glands and increases the production of sebum. Most cases are mild and transient, but if NA is severe and long-lasting, clinical and paraclinical examination will be necessary to find congenital adrenal hyperplasia or a virilizing tumor of adrenal or gonadal origin. The diagnosis of NA is clinical; its main differential -diagnoses are neonatal cephalic pustulosis, other neonatal vesiculopustular dermatoses, infectious diseases, and acneiform reactions. The resolution of NA is spontaneous. In most cases, the use of a mild dermal cleanser and water will be sufficient. For comedogenic lesions (open and closed comedones), topical retinoids or 20% azelaic acid may be used, as well as some topical antibiotics for inflammatory lesions.

El acné neonatal es una dermatosis transitoria que ocurre entre la segunda y la cuarta semanas de vida en uno de cada cinco niños. Es más frecuente en los varones, con una relación de sexo masculino-femenino de 4.5:1. Las manifestaciones clínicas incluyen comedones abiertos y cerrados que pueden progresar a lesiones inflamatorias como pápulas, pústulas eritematosas y, en casos raros, nódulos y quistes. Las zonas afectadas incluyen la frente, las mejillas, el mentón y los párpados, y en algunas ocasiones puede extenderse a la piel cabelluda, el cuello y el tronco. Ocurre por la mayor producción de andrógenos placentarios y neonatales (de origen suprarrenal en ambos sexos y de origen testicular en los varones), que provoca hipertrofia de las glándulas sebáceas y mayor producción de sebo. La mayoría de los casos son leves y autolimitados. Cuando el acné neonatal es grave y prolongado, se debe considerar la posibilidad de hiperandrogenismo, cuyas causas más frecuentes en esta edad son la hiperplasia suprarrenal congénita y los tumores, adrenales o gonadales, productores de andrógenos. El diagnóstico del acné neonatal es clínico: se debe distinguir de la pustulosis cefálica neonatal, otras dermatosis neonatales vesiculopustulares, enfermedades infecciosas y reacciones acneiformes. Habitualmente, un dermolimpiador suave y agua resultan suficientes para su manejo. Las lesiones obstructivas (comedones abiertos y cerrados) pueden requerir retinoides tópicos o ácido azelaico al 20%, y las lesiones inflamatorias, algunos antibióticos tópicos.

Leukemia cutis and other dermatological findings in pediatric patients with acute myeloid leukemia.

Background: Leukemia cutis (LC) is the infiltration of neoplastic leukocytes into the skin, causing skin lesions. In children, it appears more frequently in patients with acute myeloblastic leukemia (AML), particularly in subtypes with a monocytic component. Methods: We studied a retrospective cohort including all AML cases from the Hospital Infantil de México Federico Gómez between January 2009 to December 2019 and described the clinical characteristics of those who presented LC and other mucocutaneous manifestations. The information was collected from clinical records and analyzed using SPSS software (version 17). Results: We identified 54 AML cases: 53.7% were males, and 75.9% of the patients presented at least one dermatosis in the course of the disease. LC was clinically present in 14.8% of patients and was histologically confirmed in 9.2% of them; two congenital leukemia cases were identified. Among these patients, LC was more frequent in males. LC patients were younger than those without LC, the most frequent AML subtype was M2 (37.5%), and the most frequent clinical manifestations were plaques, chloromas, and gingival hyperplasia. None of the patients presented LC before AML diagnosis. Conclusions: Currently, only a few studies about LC on pediatric populations have been reported, and the existing ones have small sample sizes. We found clinical and epidemiological similarities with other populations in the studied sample.

Introducción: La leucemia cutis (LC) es la infiltración de leucocitos neoplásicos a la piel que provoca lesiones cutáneas. En la población infantil aparece con más frecuencia en pacientes con leucemia mieloblástica aguda (LMA), principalmente en los subtipos con componente monocítico. Métodos: Se estudió una cohorte retrospectiva en el Hospital Infantil de México Federico Gómez entre enero de 2009 y diciembre de 2019 para conocer las características clínicas de los pacientes con LMA que cursaron con LC y otras manifestaciones mucocutáneas. La información se recabó de los expedientes clínicos y se analizó con el programa estadístico SPSS versión 17. Resultados: Se identificaron 54 casos de LMA: el 53.7% en el sexo masculino y el 46.3% en el sexo femenino. El 75.9% de los pacientes presentaron alguna dermatosis durante el curso de su enfermedad. La LC se presentó clínicamente en el 14.8% de los pacientes y se confirmó histológicamente en el 9.2% de ellos; dos casos correspondieron a leucemia congénita. De estos pacientes, la LC fue más frecuente en el sexo masculino, los pacientes fueron más jóvenes que el grupo sin LC, el subtipo de LMA más frecuente fue el M2 (37.5%) y las principales manifestaciones clínicas fueron placas infiltradas, cloromas e hiperplasia gingival. Ninguno de los pacientes presentó LC antes del diagnóstico de LMA. Conclusiones: Hasta ahora existen pocos estudios de LC en las diferentes variedades de leucemia en la población infantil, y los existentes cuentan con un tamaño de muestra pequeño. En este estudio se reportan estadísticas descriptivas y se encuentran similitudes clínico-epidemiológicas con otras poblaciones.

Reducing Interruptive Alert Burden Using Quality Improvement Methodology.

BACKGROUND: Increased adoption of electronic health records (EHR) with integrated clinical decision support (CDS) systems has reduced some sources of error but has led to unintended consequences including alert fatigue. The "pop-up" or interruptive alert is often employed as it requires providers to acknowledge receipt of an alert by taking an action despite the potential negative effects of workflow interruption. We noted a persistent upward trend of interruptive alerts at our institution and increasing requests for new interruptive alerts. OBJECTIVES: Using Institute for Healthcare Improvement (IHI) quality improvement (QI) methodology, the primary objective was to reduce the total volume of interruptive alerts received by providers. METHODS: We created an interactive dashboard for baseline alert data and to monitor frequency and outcomes of alerts as well as to prioritize interventions. A key driver diagram was developed with a specific aim to decrease the number of interruptive alerts from a baseline of 7,250 to 4,700 per week (35%) over 6 months. Interventions focused on the following key drivers: appropriate alert display within workflow, clear alert content, alert governance and standardization, user feedback regarding overrides, and respect for user knowledge. RESULTS: A total of 25 unique alerts accounted for 90% of the total interruptive alert volume. By focusing on these 25 alerts, we reduced interruptive alerts from 7,250 to 4,400 per week. CONCLUSION: Systematic and structured improvements to interruptive alerts can lead to overall reduced interruptive alert burden. Using QI methods to prioritize our interventions allowed us to maximize our impact. Further evaluation should be done on the effects of reduced interruptive alerts on patient care outcomes, usability heuristics on cognitive burden, and direct feedback mechanisms on alert utility.

Low Infection-Related Re-Admission Rates in a Retrospective of 4725 Children with Appendicitis Using a Clinical Pathway in a Tertiary Care Pediatric Center.

BACKGROUND: Standardization of antibiotic management of appendicitis in tertiary care pediatric centers has been associated with improved outcomes. Rady Children's Hospital-San Diego implemented an appendicitis clinical pathway in 2005. We evaluated infection-related re-admission risk factors since 2010, when an electronic medical record was established, with the aim to optimize the clinical pathway. METHODS: Between January 2010 and August 2015, 4725 children with a diagnosis of appendicitis were evaluated for demographic data, pathology diagnoses, culture results, and inpatient and oral step-down antibiotic therapy regimens. From children originally admitted for appendicitis, those who were re-admitted with infection were compared with those who were not re-admitted for infection. The populations were controlled by severity of infection using a pathology-defined appendicitis severity scale: Grade 0, no appendicitis; grade 1, simple acute appendicitis with gross and microscopic evidence of inflammation, but no perforation; grade 2, gangrenous/necrotizing/micro-perforated appendicitis with subserosal or serosal exudate, but no frank or visually appreciated perforation; and grade 3, frank perforation. RESULTS: Of 4725 children (total population, TP) admitted with a diagnosis of appendicitis, only 199 (4.2%) were re-admitted, with 125 of these admissions for infection (2.65% of the TP). Age, race/ethnicity, language preference, and body mass index were not found to correlate with re-admission for infection. Length of stay significantly differed between the no infection-related re-admission population and infection-related re-admission population (3.02 vs. 4.03 d, p < 0.001). There was a trend toward higher infection-re-admission rates as the pathology grade increased (odds ratio grade 1 vs. grade 3 = 2.28, 95% confidence interval 1.03, 5.03). CONCLUSIONS: Infection-related re-admission rates for children on the clinical pathway in our institution were infrequent. The greater association of all-cause and infection-related re-admission rates with pathology grade suggest that defining appendicitis by pathology and clinical severity may provide an evidence-based scoring system to support clinical observation in the use and duration of antibiotic therapy.

Una nueva especie de Acanthoscurria (Araneae: Theraphosidae: Theraphosinae) sin órgano estridulador, del sur de Perú / A new species of Acanthoscurria (Araneae: Theraphosidae: Theraphosinae) without stridulatory organ, from southern Peru

Se describe Acanthoscurria sacsayhuaman sp. nov. (Araneae: Theraphosidae) en base a un macho proveniente de Cusco, Perú. Esta especie se diferencia del resto de las especies del género por la ausencia de setas estriduladoras en la cara retrolateral del trocánter del pedipalpo. Además, puede separarse por la forma del bulbo del macho y la apófisis tibial del primer par de patas. Se registra por primera vez el género para Perú.

Acanthoscurria sacsayhuaman sp. nov. (Araneae: Theraphosidae) is described based on a male from Cusco, Peru. The new species is characterized by the absence of stridulatory bristles on retrolateral face of palpal trochanter. Moreover, it can be distinguished by morphology of the male palpal bulb and tibial apophysis of the first pair of legs. The genus is recorded for the first time for Peru.

Breast cancer care in developing countries.

BACKGROUND: Breast cancer is the commonest cancer of women the world over, and its incidence is rising, especially in developing countries, where the disease poses a major health care challenge. This growing incidence in developing countries reflects the advanced stage at diagnosis, low levels of public awareness of the risk for the disease, and poor medical infrastructure and expertise, with the resultant poor treatment outcomes. METHODS: This article provides a collective edited summary of the presentations at the symposium titled "Breast Cancer Care in Developing Countries," held as part of the Breast Surgery International program at the International Surgical week 2007, Montreal, Canada, August 2007. The aim of the presentations was to bring out the diverse clinical pathological and outcomes-related facts of breast cancer care available to women in several countries. As the incidence of breast cancer continues to rise steadily in the developing world, the lack of awareness of this disease and the absence of breast cancer screening programs make it almost certain that the majority of breast cancers are diagnosed at an advanced stage. In addition, the quality of care available for breast cancer patients varies widely according to where the patient is treated. RESULTS: Though there are some centers of excellence providing multimodality protocol-based treatment on a par with the best anywhere in the world, most breast cancer patients receive inadequate and inappropriate treatment because of a lack of high-quality infrastructure-and sometimes skills-and, above all, because of limited financial resources. CONCLUSIONS: In countries where these limitations are present, there is a need to emphasize public health education, promoting early diagnosis. In addition, resources must be directed toward the creation of more public facilities for cancer treatment. As these goals are met, it is likely that there will be a much-needed improvement in breast cancer care in developing countries.

[Biliary stents for reconstruction in bile duct injuries. The role of bile acids]. / Férulas después de la reconstrucción de la vía biliar. El papel de los ácidos biliares.

UNLABELLED: Biliary stents, placed either surgically, endoscopically or radiologically are a frequent palliative and/or curative option for treatment of obstructive jaundice. Stones or sludge formation above or inside the stent are of major concern in that they cause dysfunction of the stent that needs prompt replacement. To evaluate the efficacy of ursodeoxycholic acid (UDCA) for long-term management of surgically placed biliary stents after iatrogenic injury, a prospective, controlled, randomized trial was conducted. METHOD: Patients with biliary tract reconstruction caused by iatrogenic injury that required a transanastomotic stent were randomized into a control group (N: 29) and into a UDCA (15 mg/kg day)-treated group (N: 30). Patients were followed on an external basis and a cholangiogram was obtained to verify stent patency. Liver function tests were also analyzed. RESULTS: The two groups were compared and no differences were observed. UDCA treated patients had significant elevation of transaminases and alkaline phosphatase. Two patients in the control group and four in the treated group developed lithiasis and/or sludge. CONCLUSION: No advantages were shown with administration of UDCA to maintain the biliary stents patent and to prevent neoformation of lithiasis and/or sludge. We conclude that no benefit is obtained with administration of UDCA to patients with biliary reconstruction and a transanastomotic stent.

To stent or not to stent bilioenteric anastomosis after iatrogenic injury: a dilemma not answered?

BACKGROUND: Bile duct injury is a complex and serious complication whose frequency has not diminished. A bilidigestive anastomosis (Roux-en-Y hepaticojejunostomy) is usually needed after complex injuries. Placement of an anastomotic stent is a matter of debate and to our knowledge there is no study that compares the results between stenting and not stenting the anastomosis. DESIGN: A retrospective review of medical records of patients operated on for biliary reconstruction after iatrogenic injury. SETTING: Tertiary care academic university hospital. PATIENTS: A comparative study was performed of patients operated on between 1995 and 1999, who were referred to our hospital for acute or elective reconstruction of the biliary tract following iatrogenic injury. All patients underwent Roux-en-Y hepaticojejunostomy. The patients were divided into 2 groups: those who underwent Roux-en-Y hepaticojejunostomy with a transanastomotic stent and those who underwent Roux-en-Y hepaticojejunostomy without a transanastomotic stent. MAIN OUTCOME MEASURES: Operative mortality, anastomotic dysfunction, biliary fistula, reoperations, postoperative complications, postoperative liver function tests. RESULTS: Sixty-three patients with high and complex biliary injuries (Bismuth type III, IV; Strasberg D, E). Thirty-seven cases had reconstruction with the placement of a transanastomotic stent and 26 did not have a stent placed. No operative mortality was observed. The postoperative outcomes of both groups were compared and no differences found. Good results were observed in more than 80% of the patients. Reoperations were more frequent in the nonstented group (15% vs. 5%) and complications were more frequent in the stented group (16% vs. 7%). CONCLUSIONS: Good results are obtained with a Roux-en-Y hepaticojejunostomy after complex injuries. The use of transanastomotic stents has to be selective according to the individual characteristics of each patient and the experience of each surgeon. We recommend their use when unhealthy (ie, ischemic, scarred) and small ducts (<4 mm) are found.

Artroplastia total do quadril com prótese cimentada de Charnley: avaliaçäo clínico-radiológica com seguimento mínimo de dez anos no HTO / Total hip arthroplasty with Charnley's cemented prosthesis: evaluation clinical-radiological with follow-up of 10 years in HTO

Foi realizada reavaliaçäo clínica e radiológica de 92 pacientes somando um total de 111 casos de artroplastia total do quadril com utilizaçäo da prótese cimentada de Charnley, entre 1975 e 1985, no Serviço de Quadril do Hospital de Tráumato-Ortopedia Dr. Mßrio Jorge, com seguimento mínimo de dez anos. Um total de 60 por cento das próteses cimentadas estäo estáveis, sem sinais clínicos ou radiológicos de soltura. Foram encontradas evidências de afrouxamento nos outros 40 por cento, das quais 64 por cento foram do componente acetabular, 23 por cento do femural e 23 por cento em ambos os componentes. Esse percentual está de acordo com a estatística presente nos artigos de toda a literatura mundial, permanecendo a prótese cimentada de Charnley como uma grande alternativa para as artroplastias totais do quadril.

Osteotomia tridimensional no tratamento do escorregamento epifisário superior do fêmur / Tridimensional osteotomy in the treatment of upper femoral epiphyseal slippings

O escorregamento epifisário superior do fêmur (EESF), nos graus moderado e grave, altera a biomecânica do quadril. Por isso, os autores indicam a osteotomia tridimensional na prevençÒo da artrose precoce. Foram tratados 21 quadris por esse método, obtendo um índice de 73 por cento de bons resultados, levando-os a acreditar que, com o aumento da experiência, alcançaräo ainda maior sucesso com esse procedimento.

Moraxella catarrhalis en la infecciones respiratorias altas / Moraxella catarrhalis in upper respiratory infections

Durante 12 meses se estudian las infecciones otorrinolaringológicas en dos hospitales de Lima, tanto en niños como en adultos, con especial énfasis en Moraxella catarrhalis. Se tomaron 318 muetras de igual número de pacientes, de los cuales el 40 por ciento resultó negativo a bacterias patógenas. Del 60 por ciento restante se identificó "Staphylococcus aureus" como el causante del 31 por ciento de las infecciones, seguido de "Streptococcus pneumoniae" con el 19 por ciento, luego Moraxella Catarrhalis con 16 por ciento y en cuarto lugar Haemophilus influenzae con 10 por ciento. Rinorrea purulenta fue el principal síntoma en todos los casos. Streptococcus pneumoniae, moraxella catarrhalis y Haemophilus influenzae se aislaron mayoritariamente en niños menores de 14 años. El 15 por ciento de los A. aureus fueron oxacilino-resistentes, el 11 por ciento de S. pneumoniae fueron resistentes a la penicilina, el 70 por ciento de M. catarrhalis eran productoras de B-lactamasa y el 5 por ciento de H. influenzae también producian B-lactamasa. Nuestros resultados permiten orientar mejor el tratamiento antibiótico de la infecciones respiratorias altas.

Determinaciòn de TSH para el diagnòstico precoz de hipotiroidismo neonatal: estudios previos a la implementaciòn de un programa de Tsh / Annual reports 1993 / Determination of TSH for early diagnosis of neonatal hipothyroidism: neonatal preliminary studies for the implementation of a neonatal Tsh program

En este trabajo estandarizò la toma de muestra en sangre de cordòn de recièn nacidos por goteo en papel de filtro y se adecuo la tècnica de dosaje de TSH neonatal por el mètodo IRMA, en base a la producciòn local de estandaresw y trazadores, complementados con reactivos NETRIA. Se analizaron 2500 muestras del Centro de Salud N§ 5 y de la Maternidad del Hospital de Clìnicas. El rango de TSH neonatal (Confianza del 95 por ciento), es de 13.6 +/-15.7 microUI/ml, siendo el punto de corte de 30 microUI/ml

Acetábulo rosqueado de Parhofer / Threaded acetabulum of Parhofer

Os autores avaliam o comportamento de 59 próteses acetabulares rosqueadas do tipo Parhofer aplicadas em 54 pacientes, utilizando o método de avaliaçäo clínica de Merle d'Aubigné-Postel modificado por Charnley e a avaliaçäo radiológica de Callaghan. os resultados foram de 59,4 porcento de bons resultados e 40,6 porcento de resultados insatisfatórios