[Acute myocardial infarction in childhood. Report of 2 cases]. / Infarto agudo de miocardio en la infancia. A propósito de dos casos.

We review two cases of agenesis of the left coronary trunk, a very rare congenital malformation. Both patients presented at our children's hospital with acute myocardial infarction, the mortality rate of which is high in infancy and childhood. The most common causes of myocardial infarction are anomalous origin of left coronary artery and Kawasaki disease. Less common causes are myocarditis and absence of the left coronary artery. The patients' main symptoms of acute myocardial infarction were non-specific--dyspnea and feeding problems--as is usual in acute coronary disease in children. A definitive diagnosis was made by cardiac catheterization. Both patients required surgery: saphenous vein bypass graft in one case and heart transplantation in the second. We describe both cases and review the literature.

[Inferior vena cava thrombosis after corrective surgery for tricuspid atresia (Fontan technique) in a pediatric patient]. / Trombosis en vena cava inferior tras cirugía correctora de atresia tricuspídea (Técnica de Fontán) en paciente pediátrico.

A 13-year-old boy weighing 35 Kg underwent surgery to correct pulmonary valve atresia by total caval-pulmonary anastomosis (Fontan procedure). During surgery and recovery, no adverse events were observed. On the third day after surgery, the patient developed signs of low cardiac output, renal failure, and right ventricular insufficiency. In spite of an antithrombotic treatment protocol with sodium heparin (10 IU/Kg/h), venous return was found to be impeded by 2 thrombi in the inferior vena cava. Thrombolysis with urokinase was ineffective, and surgical thrombectomy was only partially successful. Finally, a high dose of intravenous heparin was prescribed (25 IU/Kg/h) and the thrombi were dissolved. The importance of prophylactic antithromboembolic therapy following corrective surgery for congenital heart disease must be emphasized. Ultrasound monitoring of these patients, even in the absence of clinical signs, has proven effective for early detection of the thrombotic events described in this report.

[Quantifying and classifying postsurgical pain in pterygium surgery with conjunctival autografts]. / Cuantificación y cualificación del dolor postquirúrgico en la cirugía de pterigión con autoinjerto conjuntival.

OBJECTIVE: Quantify and define post-surgical pain after pterygium surgery with conjunctival autografts. MATERIAL AND METHODS: The study included 17 patients. The parameters analysed were, gender, age, pterygium TCL classification, primary characteristics or relapse, usage of isolated tissue adhesive or extra fixation with stitches. A visual analogue pain scale was used immediately after surgery, on the days 2 and 3 post-surgery, and the characteristics of the pain and the frequency of it in days 2 and 3 following the surgery. RESULTS: A total of 17 eyes of 17 patients were operated. The majority of patients (52.9%) showed moderate pain on the visual analogue scale immediately after surgery. On day 2 after surgery the pain level was mild in the majority of patients with characteristics of sharp pain and lash pain predominantly. On day 3 after surgery, mild pain was also predominant, with characteristics of stinging and lash pain in majority of patients. CONCLUSIONS: Using scales and pain characteristics we can quantify and define post-surgical pain after pterygium surgery with conjunctival auto-grafts resection immediately after surgery and in the following days.

Use of erythropoietin for bloodless surgery in a Jehovah's witness infant.

We present a case of surgery in a 2-month-old infant of the Jehovah's Witness (JW) faith weighing 2.8 kg scheduled for left upper lobectomy because of congenital lobar emphysema. He presented with physiological anaemia (haematocrit 33.8%) in accordance with his age. Because of the relative emergency of surgery, a short erythropoietin course was instituted. Recombinant human erythropoietin (rHuEPO) at a dosage of 180 U x kg-1x day-1 was administered for 10 days preoperatively and for 4 days postoperatively. Iron was administered orally and intravenously over the entire perioperative period. No side-effects from either erythropoietin or intravenously administered iron were observed. To our knowledge, this is the first case published of a short perioperative rHuEPO course in an infant.