ABSTRACT
Candida albicans es un hongo frecuentemente aislado en la cavidad oral, aunque sólo produce infección en determinados casos. Una entidad rara, principalmente en la edad pediátrica, asociada a este microorganismo es la lengua vellosa negra, una patología benigna y autolimitada pero que puede alertar por su alto impacto estético. Presentamos el caso de un preescolar varón de dos años con enfermedad inflamatoria intestinal en tratamiento inmunosupresor y antibiótico por un absceso perianal, que acude a consulta por presentar lengua negra
Candida albicans is a fungus frequently localized in oral cavity. In spite of that, it only produces disease in certain cases. A rare presentation form associated with this microorganism, mainly in pediatric age, is the black hairy tongue, a benign and self-limited pathology that can alert for its high aesthetic impact. We present the case of a two-year-old male who has black tongue in the context of inflammatory bowel disease treated with immunosuppressant and antibiotic drugs for a perianal abcess
Subject(s)
Humans , Male , Child, Preschool , Tongue, Hairy/microbiology , Candida albicans/isolation & purification , Tongue, Hairy/drug therapy , Fluconazole/therapeutic use , Antifungal Agents/therapeutic use , Nystatin/therapeutic useABSTRACT
BACKGROUND AND PURPOSE: HERBY was a Phase II multicenter trial setup to establish the efficacy and safety of adding bevacizumab to radiation therapy and temozolomide in pediatric patients with newly diagnosed non-brain stem high-grade gliomas. This study evaluates the implementation of the radiologic aspects of HERBY. MATERIALS AND METHODS: We analyzed multimodal imaging compliance rates and scan quality for participating sites, adjudication rates and reading times for the central review process, the influence of different Response Assessment in Neuro-Oncology criteria in the final response, the incidence of pseudoprogression, and the benefit of incorporating multimodal imaging into the decision process. RESULTS: Multimodal imaging compliance rates were the following: diffusion, 82%; perfusion, 60%; and spectroscopy, 48%. Neuroradiologists' responses differed for 50% of scans, requiring adjudication, with a total average reading time per patient of approximately 3 hours. Pseudoprogression occurred in 10/116 (9%) cases, 8 in the radiation therapy/temozolomide arm and 2 in the bevacizumab arm (P < .01). Increased target enhancing lesion diameter was a reason for progression in 8/86 cases (9.3%) but never the only radiologic or clinical reason. Event-free survival was predicted earlier in 5/86 (5.8%) patients by multimodal imaging (diffusion, n = 4; perfusion, n = 1). CONCLUSIONS: The addition of multimodal imaging to the response criteria modified the assessment in a small number of cases, determining progression earlier than structural imaging alone. Increased target lesion diameter, accounting for a large proportion of reading time, was never the only reason to designate disease progression.
Subject(s)
Brain Stem Neoplasms/diagnostic imaging , Clinical Trials, Phase II as Topic , Glioma/diagnostic imaging , Multimodal Imaging , Neuroimaging , Bevacizumab/therapeutic use , Brain Stem Neoplasms/pathology , Brain Stem Neoplasms/therapy , Chemoradiotherapy/methods , Child , Clinical Trials, Phase II as Topic/methods , Disease Progression , Disease-Free Survival , Female , Glioma/pathology , Glioma/therapy , Humans , Male , Multicenter Studies as Topic/methods , Multimodal Imaging/methods , Randomized Controlled Trials as Topic/methods , Temozolomide/therapeutic useABSTRACT
OBJECTIVE: To evaluate the clinically relevant abnormalities as visualized on CT and MR imaging in children with symmetric and asymmetric bilateral sensorineural hearing loss (SNHL), in relation to age and the severity of hearing loss. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral otology and audiology center. PATIENTS AND DIAGNOSTIC INTERVENTIONS: From January 2006 until January 2016, a total of 207 children diagnosed with symmetric and asymmetric bilateral SNHL were included. They underwent CT and/or MR imaging for the evaluation of the etiology of their hearing loss. MAIN OUTCOME MEASURES: Radiologic abnormalities associated with SNHL. RESULTS: 302 scans were performed in 207 children (median age of 0.8 years old) with bilateral SNHL. The most frequently identified cause of bilateral SNHL was a malformation of the labyrinth. The combined diagnostic yield of CT and MR imaging was 32%. The diagnostic yield of MR (34%) was considerably higher than that of CT (20%). We found a higher rate of abnormalities in children with profound hearing loss (41%) compared to milder hearing loss (8-29%), and in asymmetric SNHL (52%) compared to symmetric SNHL (30%). CONCLUSION: Imaging is essential in the etiologic evaluation of children with bilateral SNHL. The highest diagnostic yield is found in children with bilateral asymmetric SNHL or profound SNHL. Based on our findings, MR is the primary imaging modality of choice in the etiological evaluation of children with bilateral SNHL because of its high diagnostic yield.
Subject(s)
Hearing Loss, Bilateral/diagnostic imaging , Hearing Loss, Sensorineural/diagnostic imaging , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Adolescent , Child , Child, Preschool , Cohort Studies , Ear, Inner/abnormalities , Female , Hearing Loss, Bilateral/etiology , Hearing Loss, Sensorineural/etiology , Humans , Infant , Male , Retrospective StudiesABSTRACT
Serotonin acts through its receptors (5-HTRs) to shape brain networks during development and modulates essential functions in mature brain. The 5-HT1AR is mainly located at soma of hippocampal neurons early during brain development and its expression gradually shifts to dendrites during postnatal development. The 5-HT7R expressed early during hippocampus development, shows a progressive reduction in its expression postnatally. Considering these changes during development, we evaluated in cultured hippocampal neurons whether the 5-HT1AR and 5-HT7R change their expression, modulate dendritic growth, and activate signaling pathways such as ERK1/2, AKT/GSK3ß and LIMK/cofilin, which may sustain dendrite outgrowth by controlling cytoskeleton dynamics. We show that mRNA levels of both receptors increase between 2 and 7 DIV; however only protein levels of 5-HT7R increase significantly at 7 DIV. The 5-HT1AR is preferentially distributed in the soma, while 5-HT7R displays a somato-dendritic localization at 7 DIV. Through stimulation with 5-HT at 7 DIV during 24h and using specific antagonists, we determined that 5-HT1AR decreases the number of primary and secondary dendrites and restricts the growth of primary dendrites. The activation of 5-HT1AR and 5-HT7R promotes the growth of short secondary dendrites and triggers ERK1/2 and AKT phosphorylation through MEK and PI3K activation respectively; without changes in the phosphorylation of LIMK and cofilin. We conclude that 5-HT1AR restricts dendritogenesis and outgrowth of primary dendrites, but that both 5-HT1AR and 5-HT7R promote secondary dendrite outgrowth. These data support the role of 5-HT in neuronal outgrowth during development and provide insight into cellular basis of neurodevelopmental disorders.
Subject(s)
Dendrites/drug effects , Dendrites/metabolism , Receptor, Serotonin, 5-HT1A/metabolism , Receptors, Serotonin/metabolism , Serotonin/pharmacology , Animals , Cells, Cultured , Hippocampus/metabolism , Neurogenesis/physiology , Neurons/drug effects , Neurons/metabolism , Rats , Rats, Sprague-DawleyABSTRACT
OBJECTIVE: Evaluation of causal abnormalities identified on CT and MR imaging in children with unilateral sensorineural hearing loss (USNHL), and the association with age and severity of hearing loss. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral otology/audiology center. PATIENTS AND DIAGNOSTIC INTERVENTIONS: 102 children diagnosed with USNHL between 2006 and 2016 were included. They underwent CT and/or MR imaging for the evaluation of the etiology of their hearing loss. MAIN OUTCOME MEASURES: Radiologic abnormalities of the inner ear and brain associated with USNHL. RESULTS: Using CT and/or MR imaging, causal abnormalities were identified in 49%, which is higher than previously reported (25-40%). The most frequently affected site was the labyrinth (29%), followed by the cochlear nerve (9%) and brain (7%). No significant difference in the number or type of abnormalities was found for the degree of hearing loss or age categories. CONCLUSIONS: Imaging is essential in the etiologic analysis of USNHL because of the high prevalence of causative abnormalities that can be identified with radiology, irrespective of the patients' age or degree of hearing loss. CT and MR imaging are complementary imaging options. The ideal imaging algorithm is controversial. Based on our findings, we conclude that there is limited additional diagnostic value of simultaneous dual modality imaging over sequential diagnostics. We therefore perform a stepwise radiological workup in order to maximize the diagnostic yield while minimizing impact and costs. If the primary imaging modality does not identify a cause for USNHL, performing the alternative imaging modality should be considered. LEVEL OF EVIDENCE: Retrospective cohort study 2b.
Subject(s)
Brain/pathology , Ear, Inner/pathology , Hearing Loss, Sensorineural/etiology , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Adolescent , Audiometry , Brain/diagnostic imaging , Child , Child, Preschool , Cohort Studies , Ear, Inner/diagnostic imaging , Female , Hearing Loss, Sensorineural/diagnostic imaging , Humans , Infant , Male , Netherlands , Prevalence , Retrospective Studies , Tertiary Care CentersABSTRACT
Determination of tumor response to treatment in neuro-oncology is challenging, particularly when antiangiogenic agents are considered. Nontumoral factors (eg, blood-brain barrier disruption, edema, and necrosis) can alter contrast enhancement independent of true tumor response/progression. Furthermore, gliomas are often infiltrative, with nonenhancing components. In adults, the Response Assessment in Neuro-Oncology (RANO) criteria attempted to address these issues. No such guidelines exist yet for children. The ongoing randomized phase II trial, A Study of Avastin (bevacizumab) in Combination With Temolozomide (TMZ) and Radiotherapy in Paediatric and Adolescent Patients With High-Grade Glioma (HERBY), will establish the efficacy and safety of the antiangiogenic agent bevacizumab for the first-line treatment of newly diagnosed high-grade glioma in children (n = 121 patients, enrollment complete). The primary end point is event-free survival (tumor progression/recurrence by central review, second primary malignancy, or death). Determination of progression or response is based on predefined clinical and radiographic criteria, modeled on the RANO criteria and supported by expert pseudoprogression review and the use of standardized imaging protocols. The HERBY trial will also compare conventional MR imaging (T1-weighted and T2/fluid-attenuated inversion recovery sequences) with conventional MR imaging plus diffusion/perfusion imaging for response assessment. It is anticipated that HERBY will provide new insights into antiangiogenic-treated pediatric brain tumors. HERBY will also investigate the practicality of obtaining adequate quality diffusion/perfusion scans in a trial setting, and the feasibility of implementing standard imaging protocols across multiple sites. To date, 61/73 (83.6%) patients with available data have completed diffusion-weighted imaging (uptake of other nonconventional techniques has been limited). Harmonization of imaging protocols and techniques may improve the robustness of pediatric neuro-oncology studies and aid future trial comparability.
Subject(s)
Brain Neoplasms/diagnostic imaging , Diffusion Magnetic Resonance Imaging/methods , Glioma/diagnostic imaging , Adolescent , Adult , Angiogenesis Inhibitors/therapeutic use , Bevacizumab/therapeutic use , Brain Neoplasms/drug therapy , Brain Neoplasms/pathology , Child , Disease Progression , Disease-Free Survival , Female , Glioma/drug therapy , Glioma/pathology , Humans , Magnetic Resonance Imaging , MaleABSTRACT
INTRODUCCIÓN: El retraso diagnóstico (RD) de la enfermedad inflamatoria intestinal pediátrica (EII-P) puede conllevar la aparición de complicaciones y una menor respuesta al tratamiento. Estudiar el RD y los factores que lo condicionan ayudaría a implementar medidas correctoras y mejorar la evolución de la enfermedad. PACIENTES Y MÉTODOS: Un total de 53 casos (31 de enfermedad de Crohn [EC], 19 de colitis ulcerosa [CU] y 3 EII-P no clasificadas) entre 2000 y 2012 se evaluaron de forma retrospectiva a través de la información recogida en las historias clínicas de atención primaria y las de un Servicio de Gastroenterología infantil de un hospital terciario. La variable respuesta principal fue el tiempo entre el primer contacto médico-paciente y el diagnóstico. RESULTADOS: El tiempo mediano de RD fue de 12 semanas (rango intercuartílico 5-24). Sin embargo, un 26,3% de las CU y un 25,8% de las EC presentaron un RD superior a un año. Ninguno de los factores de riesgo estudiados se asoció significativamente a un RD relevante pero los niños de menor edad presentaron una tendencia a un mayor RD. CONCLUSIONES: Aunque el RD mediano de la EII-P parece aceptable, existe una proporción importante de niños con unas características clínicas heterogéneas y unos tiempos diagnósticos considerables. Se debería profundizar en el análisis de las oportunidades perdidas de diagnóstico
INTRODUCTION: Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease. PATIENTS AND METHODS: A retrospective study of the information collected from primary care medical records and that from the pediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out on 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified pediatric inflammatory bowel disease. The main response variable was the interval from the first physician-patient contact to diagnosis. RESULTS: The median time to diagnosis was 12 weeks (interquartile range 5-24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors was associated with a relevant diagnostic delay, although it tended to be longer in younger children. CONCLUSIONS: Whereas the median delay for pediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out
Subject(s)
Humans , Male , Female , Child , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/diagnosis , Delayed Diagnosis , Risk Factors , Crohn Disease/complications , Crohn Disease/diagnosis , Retrospective Studies , Endoscopy, Digestive System/methodsABSTRACT
INTRODUCTION: Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease. PATIENTS AND METHODS: A retrospective study of the information collected from primary care medical records and that from the pediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out on 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified pediatric inflammatory bowel disease. The main response variable was the interval from the first physician-patient contact to diagnosis. RESULTS: The median time to diagnosis was 12 weeks (interquartile range 5-24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors was associated with a relevant diagnostic delay, although it tended to be longer in younger children. CONCLUSIONS: Whereas the median delay for pediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out.
Subject(s)
Delayed Diagnosis , Inflammatory Bowel Diseases/diagnosis , Child , Child, Preschool , Female , Humans , Male , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Central nervous system (CNS) development and physiopathology are greatly affected by environmental stimuli. The intestinal barrier restricts the entrance of toxins, pathogens, and antigens while modulating the expression of various neuroactive compounds. The existence of a rich gut-to-brain communication raises the possibility that intestinal barrier alterations may take part in the pathophysiology of CNS disorders. AIM: To review evidence associating intestinal barrier dysfunction with the development of CNS disorders. METHODS: Literature search was conducted on PubMed using the following terms: intestinal barrier, intestinal permeability, central nervous system, mental disorders, schizophrenia, autism, stress, anxiety, depression, and neurodegeneration. RESULTS: Clinical and animal model studies of the association between intestinal barrier and schizophrenia, autism spectrum disorders, neurodegenerative diseases or depression were reviewed. The majority of reports concentrated on schizophrenia and autism spectrum disorders. About half of these described increased intestinal permeability/mucosal damage in patients compared with healthy controls, with up to 43% of children with autism spectrum disorders and up to 35% of schizophrenia patients displaying abnormally high urinary excretion of the sugars used as permeability markers. However, another substantial group of studies did not find such differences. In autism spectrum disorders, some reports show that the use of diets such as the gluten-free casein-free diet may contribute to the normalisation of lactulose/mannitol ratio, but to date there is no adequately controlled study showing improvement in behavioural symptoms following these dietary interventions. CONCLUSIONS: Evidence of altered intestinal permeability in individuals suffering from CNS disorders is limited and cannot be regarded as proven. Moreover the efficacy of targeting gut barrier in the management of neurological and behavioural aspects of CNS disorders has not yet been established, and needs further investigation.
Subject(s)
Central Nervous System Diseases/epidemiology , Intestinal Diseases/epidemiology , Animals , Brain/physiology , Central Nervous System Diseases/metabolism , Central Nervous System Diseases/physiopathology , Humans , Intestinal Diseases/metabolism , Intestinal Diseases/physiopathology , Intestinal Mucosa/metabolism , Intestines/physiology , PermeabilityABSTRACT
Beta-amyloid (Abeta) deposition is one important pathological hallmark in Alzheimer's disease (AD). However, low levels of Abeta may modify critical endogenous protection systems before neurodegeneration occurs. We examined the time-course effect of sublethal concentrations of Abeta on total BDNF (panBDNF), BDNF transcripts (I, II, IV and VI), trkB.FL, trkB.T1 and p75(NGFR) mRNA expression in cultured cortical neurons. We have shown that Abeta exhibited a dual response on BDNF mRNA, i.e. an increase at short times (3-5 h) and a dramatic decrease at longer times (24 or 48 h). The early increase in BDNF expression seems to be driven by increased expression of transcripts I and IV. The BDNF drop was specific since did not occur for other mRNAs examined. The BDNF protein content showed a similar profile but did not follow the dramatic reduction as its encoding mRNA. These observations may help to explain cognitive deficits observed at initial stages of AD.
Subject(s)
Amyloid beta-Peptides/metabolism , Brain-Derived Neurotrophic Factor/metabolism , Cerebral Cortex/physiology , Neurons/physiology , Peptide Fragments/metabolism , Animals , Blotting, Western , Cell Survival/physiology , Cells, Cultured , Fluorescent Antibody Technique , Immunoassay , In Situ Hybridization , Polymerase Chain Reaction , RNA, Messenger/metabolism , Rats , Rats, Sprague-Dawley , Receptor, Nerve Growth Factor/metabolism , Receptor, trkB/metabolism , Time FactorsABSTRACT
It has been widely reported a vascular and neurologic damage of the lumbar muscles produced in the classic posterior approach for lumbar spinal fusions. The purpose of this study is to demonstrate a better clinical and functional outcome in the postoperative and short term in patients undergoing minimal invasive surgery ("mini-open") for this lumbar spinal arthrodesis. We designed a prospective study with a 30 individuals cohort randomized in two groups, depending on the approach performed to get a instrumented lumbar circumferential arthrodesis: "classic posterior" (CL group) or "mini-open" approach (MO group). Several clinical and functional parameters were assessed, including blood loss, postoperative pain, analgesic requirements and daily life activities during hospital stay and at the 3-month follow-up. Patients of the "mini-open approach" group had a significant lower blood loss and hospital stay during admission. They also had significant lower analgesic requirements and faster recovery of daily life activities (specially moderate efforts) when compared to the patients of the "classic posterior approach" group. No significant differences were found between two groups in surgery timing, X-rays exposure or sciatic postoperative pain. This study, inline with previous investigations, reinforces the concept of minimizing the muscular lumbar damage with a mini-open approach for a faster and better recovery of patients' disability in the short term. Further investigations are necessary to confirm these findings in the long term, and to verify the achievement of a stable lumbar spinal fusion.
Subject(s)
Lumbar Vertebrae/surgery , Muscle, Skeletal/surgery , Postoperative Complications/prevention & control , Spinal Fusion/adverse effects , Spinal Fusion/methods , Activities of Daily Living/psychology , Adult , Cohort Studies , Female , Humans , Intervertebral Disc Displacement/surgery , Male , Muscle, Skeletal/injuries , Muscle, Skeletal/physiopathology , Pain, Postoperative/prevention & control , Patient Satisfaction , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Postoperative Hemorrhage/prevention & control , Prospective Studies , Spinal Stenosis/surgery , Treatment OutcomeABSTRACT
Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family involved in plasticity and neuroprotective processes. In recent years, we have reported the presence of BDNF mRNA in the supraoptic nucleus (SON) as well its sensitivity to osmotic stress. The rat SON is a relatively homogenous nucleus mainly consisting of magnocellular soma with their dendritic processes. BDNF may be released from dendrites to the extracellular space to stimulate tyrosine kinase (Trk) B receptors which are hypothetically present on these subcellular SON compartments. The main goal of this work was thus to study the presence and the in vivo BDNF-IR release from SON using the push-pull perfusion technique following systemic (i.p.) or local (within the SON) osmotic stimulation. BDNF was detected by immunocytochemistry and its release was measured by immunological assay (ELISA). Likewise, TrkB receptor localization in the SON-mRNA and their respective proteins-were studied by in situ hybridization and immunohistofluorescence techniques, respectively. Phosphorylation of CREB was detected by immunohistofluorescence. We present here direct evidence of in vivo dendritic BDNF release from SON which is highly sensitive to osmotic stress. The osmotic response latency period clearly depends on the mode of stimulus application (210 min for i.p. route vs. 15 min for intra-SON administration). The fact that BDNF is released as a very rapid peak when osmotic stimulation is locally applied is strong evidence in favor of an intra-SON origin of this secretion. Osmotic stress also increased phosphorylated cAMP response element binding protein immunoreactivity in the SON. In addition, we show in control rats that truncated forms of tyrosine kinase B receptor 2 mRNA represent the most abundant messenger in the SON as compared with brain-derived neurotrophic factor full-length catalytic receptor or truncated forms of tyrosine kinase B receptor 1 mRNA. In conclusion, it is likely that BDNF and their receptors are involved in neuronal plasticity changes induced by osmotic stress in the SON.
Subject(s)
Brain-Derived Neurotrophic Factor/metabolism , Receptor, Fibroblast Growth Factor, Type 2/metabolism , Stress, Physiological/pathology , Supraoptic Nucleus/metabolism , Analysis of Variance , Animals , CREB-Binding Protein/metabolism , Enzyme-Linked Immunosorbent Assay/methods , Gene Expression/physiology , In Situ Hybridization/methods , Male , Osmolar Concentration , RNA, Messenger/metabolism , Rats , Rats, Sprague-Dawley , Stress, Physiological/etiologyABSTRACT
OBJETIVOS: Determinar la distribución y características de los pacientes intervenidos en una Unidad de Cirugía Mayor Ambulatoria de Cirugía Ortopédica y Traumatología en un Hospital de tercer nivel. MATERIAL Y MÉTODOS: Muestra: N= 4451 pacientes. Estudio descriptivo de todos los pacientes intervenidos desde el año 1993 hasta el 2004 a los cuales se les ha hecho un seguimiento entre seis meses y un año. RESULTADOS: El 80% (3565) de los pacientes intervenidos en nuestra unidad fueron mujeres. La media de edad fue de 58´2 años. Las patologías más frecuentes fueron: Hallux valgus 1608 (36%), Dedo en martillo 964 (22%) y SDM túnel carpiano 642 (13%). El 96% de las intervenciones se realizaron bajo anestesia local y sedación. El dolor postoperatorio fue ausente o leve en la mitad de los casos (48´73%). La tasa de complicaciones postoperatorias fue del 2´5%, predominando los problemas de cicatrización (1´12%) y la infección de herida (0´9%). La tasa de ingreso fue del 0´16%. La necesidad de atención por el Servicio de Urgencias fue de 1,9% y la satisfacción subjetiva a los 3 o 6 meses de nuestros pacientes fue de "contentos" o "muy contentos" en el 96´61% de los casos (..) (AU)
OBJETIVES: To determine the distribution and characteristics of patients undergoing ambulatory surgery in Traumatology in a third level hospital. METHODS: A descriptive study of 4451 outpatient surgical procedures, performed between January 1993 and May 2004, was undertaken, with a six months to one year follow-up. RESULTS: 80% (3565) of patients requiring surgical procedures in our Unit were women. Mean age was 58.2 years. The most frequent pathologies were: Hallux valgus 1608 (36%), hammer toe procedures 964 (22%) and Carpal Tunnel Release 642 (13%). 96% of the operations were performed under local anesthesia and sedation. Postoperative pain was non-existent or mild in half of patients (48.73%). Post-operative rate of complications was 2.5%, mainly scartissue problems (1.12%) and infection (0.9%). The unplanned hospital admission rate was 0.16%. The need for emergency care was 1.9% and subjective satisfaction after 3 or 6 months was "good" or "excellent" in 96.61% of the patients (AU)
Subject(s)
Male , Female , Middle Aged , Humans , Orthopedics/standards , Orthopedics/trends , Ambulatory Surgical Procedures/methods , Ambulatory Surgical Procedures , Hallux Valgus/diagnosis , Hallux Valgus/therapy , Anesthesia, Local/methods , Traumatology/methods , Orthopedics , Orthopedics/methods , Epidemiology, Descriptive , Emergencies/epidemiologyABSTRACT
No disponible
Subject(s)
Infant , Humans , Celiac Disease/epidemiology , Risk Factors , Glutens/adverse effects , Celiac Disease/physiopathology , Cross-Sectional StudiesABSTRACT
Objetivo: Obtener un mejor conocimiento del comportamiento de una población de pacientes con diagnóstico de atresia de vías biliares en las distintas fases de la enfermedad. Pacientes y métodos: Estudio retrospectivo, transversal y descriptivo, tipo serie de casos clínicos. Pacientes con diagnóstico de atresia de vías biliares atendidas en la Unidad de Gastroenterología del Hospital Infantil La Fe de Valencia desde enero de 1990 a diciembre del 2000. Resultados: De los 16 niños controlados, en el momento actual permanecen estables ocho, han precisado trasplante hepático seis y han fallecido dos. La edad media al diagnóstico es de 47,5 días de vida. La manifestación clínica más frecuente es la ictericia (87,5 por ciento), y el hallazgo analítico más importante el aumento de la gamma glutamiltranspeptidasa (GGT) (3-4 veces su valor de referencia) en el 100 por ciento de los casos. Las imágenes ecográficas son diagnósticas en el 85,7 por ciento. El Hepato-Hida ofrece una sensibilidad del 100 por ciento. El tratamiento quirúrgico mediante portoenterostomía se realizó en todos los pacientes, con biopsia hepática en el mismo acto. La precocidad en la intervención se refleja en un mejor pronóstico a largo plazo, siendo mejor si ésta se realiza antes de los 65 días de vida. Conclusiones: Un alto índice de sospecha permite el tratamiento quirúrgico precoz, única medida terapéutica que puede condicionar un pronóstico menos desfavorable (AU)
Subject(s)
Humans , Male , Infant, Newborn , Infant , Female , Retrospective Studies , Sensitivity and Specificity , Biliary Atresia , Cross-Sectional Studies , Biliary AtresiaABSTRACT
OBJECTIVE: To gain further insight into the natural history of patients with biliary atresia. PATIENTS AND METHODS: We performed a retrospective, cross-sectional, descriptive, case series study. All patients with biliary atresia attended at the Pediatric Gastrointestinal and Hepatology Unit of La Fe Children's Hospital in Valencia (Spain) from January 1990 to December 2000 were included. RESULTS: Of 16 children followed-up, eight are currently stable, six have undergone liver transplantation and two died. The mean age at diagnosis was 47.5 days. The most frequent clinical manifestation was jaundice (87.5%) and the most common biochemical finding was raised gamma-glutamyltransferase (3-4 times its standard value), which appeared in 100 % of the patients. Abdominal ultrasonography was diagnostic in 85.7% of the patients. Nuclear scintiscan (DISIDA) showed a sensitivity of 100%. Portoenterostomy with intraoperative liver biopsy was performed in all patients. Patient age at surgery was a predictor of long-term outcome, with more favorable results in patients aged less than 65 days of life. CONCLUSIONS: Biliary atresia should be suspected as soon as possible, since early surgical treatment is the only therapeutic measure that can improve outcome.