Role of VV ECMO tracheal surgery and carinal resection: Two case reports.

The aim of this study is to describe the anaesthesia management of two patients undergoing carinal resection under veno-venous extracorporeal membrane oxygenation (VV ECMO). In both cases, anaesthesia was induced and then maintained with inhalational agents during pneumonectomy and mediastinoscopy (respectively). Then the jugular and femoral veins were cannulated and VV ECMO was started after heparinization. One of the patients presented bleeding during surgery, which was treated with low-dose vasopressors (norepinephrine) and transfusion of platelets, fresh frozen plasma, and concentrated red blood cells. During VV ECMO, anaesthesia was maintained with target-controlled infusion of propofol. VV ECMO can be expected to improve surgical conditions in tracheal surgery; however, it is still a novel technique in this context. In selected patients, it would guarantee ventilatory support during carinal resection, but it is essential to carefully plan anaesthesia maintenance and prepare for VV ECMO-related complications. This technique should only be used in tertiary centres with experience in VV ECMO management.

Are compatible solutes compatible with biological treatment of saline wastewater? Batch and continuous studies using submerged anaerobic membrane bioreactors (SAMBRs).

This study investigated fundamental mechanisms that anaerobic biomass employ to cope with salinity, and applied these findings to a continuous SAMBR. When anaerobic biomass was exposed to 20 and 40 g NaCl/L for 96 h, the main solute generated de novo by biomass was trehalose. When we separately introduced trehalose, N-acetyl-ß-lysine and potassium into a batch culture a slight decrease in sodium inhibition was observed. In contrast, the addition of 0.1 mM and 1 mM of glycine betaine dramatically improved the adaptation of anaerobic biomass to 35 g NaCl/L, and it continued to enhance the adaptation of biomass to the salt for the next three batch feedings without further addition. No shift in archaeal microbial diversity was found when anaerobic biomass was exposed in batch mode to 35 g NaCl/L for 360 h, and no changes were found when glycine betaine was added. The dominant species identified under these conditions were Methanosarcina mazeii and Methanosaeta sp. The addition of 5 mM glycine betaine to a continuous SAMBR at 12 h hydraulic retention time (HRT), and operation in batch mode for 2 days can significantly enhance saline (35 g NaCl/L) synthetic sewage degradation. In addition, the injection of 1 mM of glycine betaine into a SAMBR for five subsequent days also significantly enhanced dissolved organic carbon (DOC) removal from sewage under these conditions. The main compatible solutes generated by anaerobic biomass after 44 days exposure to 35 g NaCl/L in a SAMBR were N-acetyl-ß-lysine and glycine betaine. Finally, the addition of 1 mM glycine betaine to the medium was beneficial for anaerobic biomass in batch mode at 20 °C under saline and non saline conditions.

[Childhood cholelithiasis. Analysis of 24 patients diagnosed in our department and review of 123 cases published in Spain]. / Colelitiasis en la infancia. Análisis de 24 pacientes y revisión de 123 casos publicados en España.

INTRODUCTION: Childhood cholelithiasis is being increasingly diagnosed worldwide, particularly in Spain. We retrospectively analyzed several epidemiological, clinical, diagnostic, etiologic and therapeutic aspects of this disease in 123 pediatric cases reported in Spain since 1971. PATIENTS AND METHODS: Twenty four patients with cholelithiasis were diagnosed in our department between 1981 and 1999. Data on sex, age at diagnosis, form of clinical presentation, imaging studies used in diagnosis, etiology and underlying associated diseases, complications and treatment were retrospectively analyzed. The data obtained on the patients in our study were compared with and added to those of a further 99 pediatric cases published in Spanish medical journals since 1971. Cases diagnosed during the neonatal period were not included. RESULTS AND CONCLUSIONS: The main findings were the following. The mean age at diagnosis was 7.8 years. The percentage of males was 51% and that of females was 49%. A total of 33.3% of the patients were asymptomatic and 66.6% were symptomatic. The most frequent symptoms were abdominal pain with or without vomiting (94%), jaundice (13.4%) and fever (9.7%). Etiology was idiopathic in 60.2% of patients and secondary in 39.8%. In the latter group the main causes of cholelithiasis were hemolytic anemia in 19 patients, obesity in 12, biliary tract malformations, hypercholesterolemia and liver disease in 4, and cystic fibrosis in 3. Diagnosis was based on abdominal ultrasonography in 89.4% of the patients and on Xray in 60.1%. Complications found were cholecystitis in five patients and pancreatitis in seven. One child with pancreatitis died from acute respiratory distress syndrome. Surgical treatment was given to 55.3% of the patients while 43.9% were treated conservatively. In one child cholelithotripsy was used.

Colelitiasis en la infancia. Análisis de 24 pacientes y revisión de 123 casos publicados en España / Childhood cholelithiasis. Analysis of 24 patients diagnosed in our department and review of 123 cases published in Spain

OBJETIVO: La litiasis biliar infantil, es una enfermedad que se está diagnosticando cada vez con más frecuencia en el mundo en general y en España en particular. En este trabajo se han analizado de manera retrospectiva diferentes aspectos epidemiológicos, clínicos, diagnósticos, etiológicos y terapéuticos de 123 pacientes pediátricos con esta enfermedad publicados en España desde el año 1971. PACIENTES Y MÉTODOS: Desde 1981 a 1999 se han diagnosticado en el Departamento de Pediatría del Hospital Universitario San Carlos 24 pacientes con litiasis biliar. Se analizaron de manera retrospectiva resultados porcentuales y numéricos sobre su sexo, su edad en el momento del diagnóstico, la forma de presentación clínica de la enfermedad, las pruebas de imagen utilizadas para el diagnóstico, la etiología o enfermedades asociadas al proceso de base, las complicaciones acaecidas y el tratamiento efectuado. Por otra parte, los datos obtenidos en nuestra población se han comparado y reunido con otros 99 pacientes pediátricos publicados en las principales revistas médicas españolas desde 1971. No se han considerado los casos diagnosticados en el período neonatal. RESULTADOS Y CONCLUSIONES: Las conclusiones y resultados más importantes encontrados han sido los siguientes. La edad media de los pacientes al diagnosticarse la enfermedad fue de 7,8 años. La proporción de mujeres y varones fue de 51 y 49%, respectivamente. Los sujetos asintomáticos representaron el 33,3%, y los sintomáticos el 66,6%. Los síntomas más frecuentes fueron el dolor abdominal con vómitos o sin ellos (94%), la ictericia (13,4%) y la fiebre (9,7%). La etiología de la litiasis biliar fue idiopática en el 60,2% de los casos y secundaria en el 39,8% restante. De las causas secundarias, las más frecuentes fueron las anemias hemolíticas en 19 pacientes, la obesidad en 12, las malformaciones de la vía biliar, la hipercolesterolemia y hepatopatías en cuatro, y la fibrosis quística en tres. La ecografía abdominal fue la técnica diagnóstica empleada en el 89,4% de los pacientes, mientras la radiografía simple de abdomen lo fue en el 60,1%. En 5 niños se produjo como complicación una colecistitis y en siete una pancreatitis. Un caso falleció por una pancreatitis que desarrolló síndrome de distrés respiratorio de tipo agudo (SDRA). En el 55,3% de los pacientes se realizó tratamiento quirúrgico, mientras en el 43,9% fue conservador. En 1 niño se empleó la litotricia extracorpórea (AU)