Respuesta al comentario al artículo "Sedación con sevoflurano para resonancia magnética en pediatría: estudio clínico retrospectivo de 5.864 casos" / No disponible

No disponible

[Sedation with sevoflurane for magnetic resonance imaging in pediatrics: retrospective study of 5864 cases]. / Sedación con sevoflurano para resonancia magnética en pediatría: estudio clínico retrospectivo de 5864 casos.

OBJECTIVE: To evaluate the use of sevoflurane for sedating pediatric patients undergoing magnetic resonance imaging studies. MATERIAL AND METHODS: Data were extracted retrospectively from the records of 5864 pediatric patients (aged 0-18 years) who had undergone magnetic resonance imaging studies in our hospital from 1999 to 2004. Sevoflurane was usually administered at high concentrations of up to 7% on induction; after 2 minutes the concentration was reduced. The patient, breathing spontaneously, was kept sedated with a sevoflurane concentration of 1.5% to 2% in a mixture of 50% nitrous oxide and 50% oxygen. RESULTS: Optimal sedation was achieved in 5789 (98.72%) of the cases treated. Complications included 11 episodes of vomiting, 53 cases (0.9%) of mild respiratory depression, 6 cases of severe respiratory depression on induction, and 5 cases of agitation. There were no cases of prolonged sedation. CONCLUSION: Sevoflurane is useful for sedating pediatric patients in the setting of this study. Induction is rapid and gentle, and maintained sedation is constant, stable and homogeneous. Awakening and recovery are rapid, and the incidence of complications low.

Sedación con sevoflurano para resonancia magnética en pediatría: estudio clínico retrospectivo de 5.864 casos / Sedation with sevoflurane for magnetic resonance imaging in pediatrics: retrospective study of 5864 cases

OBJETIVO: Valorar la idoneidad del sevoflurano comoagente para la sedación de pacientes pediátricos a losque se practicó una exploración por resonancia magnética(RM).MATERIAL Y MÉTODOS: De manera retrospectiva, serecogieron datos de 5.864 pacientes pediátricos (0 a 18años) a quienes se realizó una RM entre 1999 y 2004 ennuestro centro. La pauta habitual fue administrar sevofluranoen concentraciones elevadas, hasta un 7% en lainducción que se reducía transcurridos 2 minutos. Elpaciente se mantenía con respiración espontánea, conuna concentración de 1,5-2% de sevoflurano con usoconcomitante de óxido nitroso y oxígeno al 50%.RESULTADOS: La sedación resultó óptima en 5.789(98,72%) de las sedaciones practicadas. Las complicacionesfueron: 11 episodios de vómitos; 53 pacientes(0,9%) sufrieron episodios de depresión respiratorialeve; 6 pacientes sufrieron depresión grave al inicio de lainducción, y hubo 5 episodios de agitación. No hubocasos de sedación prolongada.CONCLUSIÓN: El sevoflurano resulta un fármaco útilpara la sedación de pacientes pediátricos en el ámbitoempleado, permitiendo una inducción rápida y suave,mantenimiento constante, estable y homogéneo, fácilrecuperación y rápido despertar, reportando un índicemínimo de complicaciones(AU)

OBJETIVE: To evaluate the use of sevoflurane forsedating pediatric patients undergoing magnetic resonanceimaging studies.MATERIAL AND METHODS: Data were extractedretrospectively from the records of 5864 pediatric patients(aged 0-18 years) who had undergone magnetic resonanceimaging studies in our hospital from 1999 to 2004.Sevoflurane was usually administered at highconcentrations of up to 7% on induction; after 2 minutesthe concentration was reduced. The patient, breathingspontaneously, was kept sedated with a sevofluraneconcentration of 1.5% to 2% in a mixture of 50% nitrousoxide and 50% oxygen.RESULTS: Optimal sedation was achieved in 5789(98.72%) of the cases treated. Complications included 11episodes of vomiting, 53 cases (0.9%) of mild respiratorydepression, 6 cases of severe respiratory depression oninduction, and 5 cases of agitation. There were no cases ofprolonged sedation.CONCLUSION: Sevoflurane is useful for sedatingpediatric patients in the setting of this study. Induction israpid and gentle, and maintained sedation is constant,stable and homogeneous. Awakening and recovery arerapid, and the incidence of complications low(AU)

Radioisotope shuntograms at the Children's Hospital of Eastern Ontario.

INTRODUCTION: Nuclear medicine shuntograms using the radiotracer technetium-99m diethylenetriaminepentaacetic acid have been used for many years as an additional method to assess shunt patency and performance. METHODS: The medical records of all children who had shuntograms performed at the Children's Hospital of Eastern Ontario between January 13, 2000, and January 10, 2003, were retrospectively reviewed. There was a total of 68 procedures in 56 patients with an average age of 9 years 3 months. During the same period there were 123 shunt revisions. RESULTS: Forty-two shuntograms were reported as normal. Of these, ten were identified to be false negative. Two children with fractured shunts had shuntograms performed in order to assess for cerebrospinal fluid flow patency; the shuntograms were identified to be normal, confirming shunt dependence, and the shunt replaced. Twenty-six shuntograms were reported as abnormal in 24 patients; 17 went on to have surgery and the shunt malfunction was confirmed. Seven patients did not require surgery: five were declared shunt independent, two patients clinically improved after severe constipation was treated. CONCLUSIONS: Approximately one fourth of all shuntograms reported as normal are not (false-negative rate=25%). Review of five other major studies between 1980 and 2003 have reported false-negative rates between 2 and 36%, which may be explained by variations in shuntogram protocols. A standardized method is proposed.

A prospective randomized trial comparing 2 diuresis renography techniques for evaluation of suspected upper urinary tract obstruction in children.

PURPOSE: We compare the diagnostic impact of 2 diuresis renography techniques for evaluation of suspected upper urinary tract obstruction in children. MATERIALS AND METHODS: A total of 72 children were randomly assigned to 1 of 2 standardized diuresis renography protocols. The protocols were identical, except for the time of furosemide (F) injection. In the F+20 scans furosemide was given 20 minutes after the 99mtechnetium pentetic acid radiopharmaceutical. With the modified F-15 scans furosemide was injected 15 minutes before renography. Hydration, bladder catheterization, urine output determination, radiopharmaceutical injection and scan acquisition were identical. Renography outcomes (obstructed, nonobstructed or equivocal) were analyzed for the investigated side(s) and for the contralateral side, which was used as a control in children with suspected unilateral obstruction. Chi-square test was used to compare the percentage of obstructed and nonobstructed scans of both protocols. Fisher's exact test was used to compare the nonobstructed scans and equivocal results of both protocols. RESULTS: Of the 96 scans performed 8 were excluded because of technical problems. The remaining scans included 44 F+20 and 44 F-15. Of the 88 scans 10 were used to evaluate possible bilateral obstruction. A total of 48 boys and 24 girls were evaluated. Because 2 children had a solitary kidney each, the total number of renal units studied for outcome was 174. The F-15 scan showed 7 times more obstruction than the F+20 scan on the investigated side, and this difference was statistically significant. No obstruction was diagnosed on the contralateral side with either technique when used to investigate cases of suspected unilateral obstruction. CONCLUSIONS: The timing of the furosemide injection (F-15 scan versus F+20) has a significant impact on the obstructive versus nonobstructive renography results when evaluating children with suspected upper urinary tract obstruction.

Reliability of potential clinical measures of muscle tone in the elbows of patients after stroke.

OBJECTIVES: This study investigated the reliability of joint resting position (EJP), resistance to passive movement (ERM), and the angle of appearance of the resistance (EAR) as measures of muscle hypertonus of elbow flexors in patients after stroke. Previously, similar measures had been found reliable when applied to measuring shoulder and wrist hypertonus in patients after stroke. METHOD: Forty-five subjects with stroke were randomly selected from occupational therapy admissions at two rehabilitation centers. Tone of elbow flexors was measured twice at the same sitting by two examiners. EJP and EAR were measured with a goniometer, and ERM was measured with a resistance rating scale. Correlations were calculated between first and second measurements by center and by high tone and poor upper extremity function subgroups (with correction for multiple correlations) to determine reliability. RESULTS: Each of the three measures was highly reliable as demonstrated by a high correlation in at least one of the subgroups (Center 1: EJP, r = .964 for high tone subgroup; ERM, r = .789, EAR, r = .902, both in poor upper extremity function subgroup; and Center 2: EJP, r = .892, ERM, r = .938, both in poor upper extremity function subgroup; EAR, r = .666 for all subjects; all p values < .05). Correlations were especially high when data for subjects with high upper extremity function were eliminated. CONCLUSION: Reliability of these three methods of measuring upper extremity muscle tone enhances their usefulness as well as therapists' confidence in their judicial application.

Immigration policy and the U.S. economy: an institutional perspective.

The author examines some aspects of the current situation concerning immigration to the United States. He predicts that the 1990s will witness the largest flow of immigrants into the population and labor force of any decade in the country's history; furthermore, since there is no universally accepted right to immigrate, the adoption of migration policy is one area of economic policymaking that is not controlled by market forces. He also notes that while the country's need is for a highly skilled, motivated, and educated labor force, the majority of current immigrants have low skill levels and relatively little education. The need to develop and implement a migration policy that is in tune with the country's economic objectives is stressed. He concludes that "the resurrection of mass immigration from out of the nation's distant past was a political accident; its perpetuation in the 1990s is contrary to national interest. Immigration reform, therefore, needs to be [in] the forefront of the nation's economic policy agenda."

U.S. asylum policy and the New World Order.

PIP: US policy on refugees was developed as an ad hoc response to the problem of displaced persons in Europe following the Second World War and quickly became a foreign policy tactic to be manipulated in the context of the Cold War political struggle. It was not until 1980 that the US formally adopted an asylee policy in legislative forum. That policy, too, was affected by the Cold War. The dismantlement of the Berlin Wall in 1989 and the subsequent collapse of the Soviet Union in 1991, however, have radically changed the dynamics of refugee and asylee issues. Refugee and asylee pressures are increasingly being linked with the broader worldwide issues of population growth, unbalanced economic development, and migration pressures. New refugee and asylum policies are required in the new world order which are not predicated upon the need to respond to communism. These policies must be reserved for truly persecuted individuals. The author discusses the creation of an asylum policy, mass asylum, and pending policy reforms. The refugee system provides a means of access for many people looking to escape the poverty, unemployment, and destitution of their homeland. Asylum policy is the most vulnerable element of refugee policy for exploitation. To alleviate the economic forces which lie at the core of asylum abuse will require more fundamental policies than the procedural changes currently under consideration by Congress or those proposed by President Clinton. Among them must be policies which promote family planning and provide the means for its practice; expand commitments to economic development assistance; and link trade access to the US marketplace and the receipt of foreign aid to the strict adherence of internationally specified human rights practices.^ieng

Plain film and CT observations in prostaglandin-induced bone changes.

Prostaglandin E1 intravenous infusion is used in infants with ductal-dependent congenital heart disease to maintain ductal patency and prolong life until palliative or corrective surgery is feasible. Complications of prostaglandin administration include fever, diarrhoea, hypotension, apnoea, bradycardia, pseudowidening of the cranial sutures, underossification of the calvarial bones, periostitis, and skin edema [1-3]. This paper presents dramatic plain radiographic features of prostaglandin-induced bone disease, including periosteal proliferation and the unusual bone-within-bone appearance, and provides the previously unpublished CT correlation.

The growth and composition of the U.S. labor force.

In sharp contrast with the experiences of all other industrialized nations, the size of the labor force of the United States is growing rapidly while, simultaneously, its age, gender, and ethnic composition are changing markedly. Consequently, human resource issues present an unprecedented challenge in the nation's quest to achieve a fully employed and equitable society. New public policies that focus on labor market adjustment policies will be required if these developments are to be a boon rather than a bane to the emerging postindustrial economy.

The "albatross" of immigration reform: temporary worker policy in the United States.

PIP: The author examines the history of U.S. labor and immigration policies, paying particular attention to the evolution of the temporary worker policy. Complications in the immigration reform process caused by efforts to admit more temporary workers are discussed. The position of the Reagan administration, Senate and House consideration of immigration and temporary worker bills, and the political controversies surrounding this issue are reviewed. The author points out that it was not until the major temporary worker proposals were finally removed from the Simpson-Rodino Act that passage of legislation was achieved, and he anticipates that efforts will eventually be made to revive temporary worker policy and thereby rekindle the debate^ieng

Esophageal duplication cyst containing a foreign body.

About 10% to 15% of all duplication cysts in the alimentary tract are esophageal. Esophageal duplication cysts are intimately attached to the alimentary tract, are lined by mucous membrane and have smooth muscle. This paper describes a 2-year-old child who presented with symptoms of progressive respiratory distress. A diagnosis of esophageal duplication cyst was made. At surgery a low cervical incision was made and the sternal manubrium split, thereby providing adequate exposure. The cyst was then removed. The most useful investigations were chest roentgenography and barium esophagography. Computerized tomography showed a small, round foreign body in the middle of the cyst that was subsequently found to be a bingo chip. Communication between the cyst and the esophagus was not obvious at the time of surgery and had not been demonstrated by barium esophagography. When complete excision of the cyst is not possible because of inflammatory reaction all the mucosa must be removed to prevent recurrence. Careful postoperative respiratory support and broad-spectrum antibiotic therapy are recommended.

Methods of analysis of illegal immigration into the United States.

PIP: The inadequacy of existing data on illegal immigration to the United States is described. The attempts that have been made by various government agencies and individual researchers to measure the extent and employment impact of illegal immigrants are then reviewed.^ieng