Análisis de coordenadas polares en los porteros de fútbol: diferencias de género / Analysis of polar coordinates in football goalkeepers: gender differences

El objetivo del presente estudio fue determinar el perfil de actividad y los requerimientos físicos (distancia total recorrida, velocidad) y tácticos (desplazamiento por mapa de calor) en la competencia en los porteros/as de fútbol universitario en Bogotá a lo largo 64 partidos, implementando dispositivos GPS. El tratamiento de los datos estadísticos se realizó mediante el programa R en distintas fases; análisis descriptivo, un análisis de varianza y un análisis descriptivo espacial para las coordenadas polares. Los resultados mostraron que existen diferencias significativas entre la distancia recorrida en cada una de las categorías de velocidad y entre la distancia recorrida por hombres y mujeres con análisis de varianza (categoría 1: 0.016; categoría 2: 0.0088). Finalmente, los perfiles de actividad de los porteros deben considerar unas categorías de locomoción que establezcan rangos de velocidad específicos a las necesidades de su posicionamiento. (AU)

The principal objective of this study was to determine the activity profile and the physical requirements (total distance traveled, speed) and tactics (displacement by heat map) in the competition in the goalkeepers of university soccer in Bogotá over 64 games, implementing GPS devices. The treatment of statistical data was carried out using the R program in different phases; descriptive analysis, an analysis of variance, and a descriptive spatial analysis for the polar coordinates. The results showed that there are significant differences between the distance traveled in each of the speed categories and between the distance traveled by men and women with analysis of variance (category 1: 0.016; category 2: 0.0088). Finally, the activity profiles of goalkeepers should consider locomotion categories that establish speed ranges specific to their positioning needs. (AU)

A real-life overview of a hematopoietic cell transplant program throughout a four-year period, including prospective registry, exclusion causes and final donor selection.

Traceability of patients who are candidates for Hematopoietic cell transplant (HCT) is crucial to ensure HCT program quality. Continuous knowledge of both a detailed registry from a HCT program and final exclusion causes can contribute to promoting a real-life vision and optimizing patient and donor selection. We analyzed epidemiological data reported in a 4 year-monocentric prospective registry, which included all patients presented as candidates for autologous (Auto) and/or allogeneic (Allo) HCT. A total of 543 patients were considered for HCT: 252 (42.4%) for Allo and 291 (57.6%) for Auto. A total of 98 (38.9%) patients were excluded from AlloHCT due to basal disease progression more commonly (18.2%). Seventy-six (30.2%) patients had an HLA identical sibling, whereas 147 (58.3%) patients had only Haplo. UD research was performed in 106 (42%) cases, significantly more often in myeloid than lymphoid malignancies (57% vs 28.7%, p < 0.001) but 61.3% were finally canceled, due to donor or disease causes in 72.4%. With respect to Auto candidates, a total of 60 (20.6%) patients were finally excluded; progression was the most common cause (12%). Currently, Haplo is the most frequent donor type. The high cancellation rate of UD research should be revised to optimize further donor algorithms.

Advantages of non-cryopreserved autologous hematopoietic stem cell transplantation against a cryopreserved strategy.

Autologous stem cell transplantation (auto-HSCT) is an effective treatment strategy for hematological malignancies. The standard mode of handling hematopoietic progenitors for the autologous procedure (CRYO) consists on its collection and freezing with dimethyl sulfoxide (DMSO) and its subsequent thawing and re-infusion. This process is toxic and expensive. Non-cryopreserved (non-CRYO) is a less expensive mode of auto-HSCT. We designed a comparative study between both strategies performed in two different centers to analyze the short-term complications. In total 111 auto-HSCT were performed from January/2015 to October/2016 (42 non-CRYO and 74 CRYO). There were 74 males and 69 (62%) patients had the underlying diagnosis of multiple myeloma. No differences were seen on the characteristics of the apheresis products and their viability. Engraftment was significantly faster in the non-CRYO group (p = 0.001). Febrile neutropenia and severe mucositis were lower in the non-CRYO group (40% vs 92% p = 0.0001 and 11% vs 64%, p = 0.001, respectively). In addition, length of hospitalization was 5 days shorter in the non-CRYO group (p = 0.0001). Overall responses and transplantation outcomes were similar. Our data demonstrate a clear advantage of the non-CRYO over CRYO auto-HSCT with faster engraftment, lower incidence of febrile neutropenia and shorter hospital stay after the transplantation procedure. These data are especially relevant for centers with high transplant activity or with limited resources.

Etiology, clinical features and outcomes of pre-engraftment and post-engraftment bloodstream infection in hematopoietic SCT recipients.

We conducted an observational study to assess the etiology, clinical features and outcomes of bloodstream infection (BSI) in 172 hematopoietic SCT (HCST) recipients. One hundred episodes of BSI in the pre-engraftment period (early onset) were compared with 89 episodes in the post-engraftment phase (late onset). More patients with late-onset BSI received an allogeneic HSCT, had GVHD and had received corticosteroids, whereas patients with early-onset BSI were more likely to have neutropenia, severe mucositis and a central venous catheter (CVC) in place. CVC was the most frequent site of infection, followed by an endogenous source. Pneumonia and gastrointestinal infection were particularly frequent in late-onset BSI, whereas mucositis was more frequent in the early-onset group. Gram-positive organisms predominated over Gram negatives. Streptococcus pneumoniae was more frequent in patients with late-onset BSI. Patients with late-onset BSI presented worse outcomes regarding septic shock, intensive care unit admission and early and overall case-fatality rates. Early-onset BSI was mainly related to the presence of neutropenia, mucositis and CVC, whereas late-onset BSI mainly affected severely immunosuppressed allogeneic HSCT recipients with GVHD and corticosteroids. Late-onset BSI caused high case-fatality rates. BSI due to S. pneumoniae was especially frequent late after transplantation. The development of better vaccination strategies is needed.

Malnutrición y seguridad alimentaria: un estudio multinivel / Malnutrition and food security: a multilevel study

En 1488 sujetos y 432 hogares se establecieron las variables asociadas al estado de nutrición (EN) de los sujetos y malnutrición del hogar, y el efecto de la inseguridad alimentaria (INSA) sobre estos estados. El EN se estableció mediante antropometría. La malnutrición del hogar con base en el EN. La INSA con base en el consumo de calorías durante 24 horas además de la percepción del jefe del hogar. Mediante regresiones logística multinomial y binomial se establecieron razones de prevalencia (RP) para las variables y el EN y la malnutrición. En sujetos el riesgo de déficit de peso es 3,9 veces mayor en el ámbito rural, y 4,4 veces más en los que apenas han cursado primaria o menos. Las mujeres tienen 1,4 más riesgo de exceso de peso, por cada cinco años de edad el exceso de peso aumenta en 30%, en los sujetos sin apoyo alimentario 1,7 veces. En hogares el nivel socioeconómico bajo tiene 1,9 veces más riesgo de malnutrición, los hogares sin menores de edad 3,1 y los urbanos 1,6 veces más riesgo. La INSA no esta asociada al EN, ni a la malnutrición. El apoyo alimentario a sujetos aparentemente protege contra el exceso de peso. Sujetos y hogares urbanos tiene mayor riesgo de exceso y malnutrición.

The variables associated with nutritional status (EN), household malnutrition, and food insecurity (INSA) was evaluated in 1488 subjects living in 432 homes. The NE was determined by anthropometric measures and the INSA was based on the calorie intake of 24 hours and on the perception of the household head. Prevalence ratios (PR) were established using binomial and multinomial logistic regressions. The risk of weight deficit in subjects was 3.9 (CI 95%: 1.2 to 11.9) times higher in the rural than in the urban areas, and 4.4 (CI 95%: 1.3 to 14.8) times more when they had primary school or less. Women had 1.4 times (CI 95%: 1.0 to 1.8) higher risk of overweight for each five years of age increase. Households with low socioeconomic level had 1.9 (CI 95%: 1.2 to 2.9) times more risk of malnutrition when children were not present. The INSA was not associated with the EN or malnutrition. Food support in subjects apparently protected against excess weight. Urban subjects and households were at greater risk of having excess weight and malnutrition.

Contamination of barley seeds with Fusarium species and their toxins in Spain: an integrated approach.

Fusarium is a globally distributed fungal genus that includes different species pathogenic to cereals among others crops. Some of these Fusarium species can also produce toxic compounds towards animals and humans. In this work, the presence of the most important Fusarium toxins was determined in barley seeds from Spain, sampled according to European Union requirements. The results obtained were compared with the presence of mycotoxigenic species considered responsible for their synthesis by using species-specific polymerase chain reaction protocols. Fumonisins B(1) and B(2), zearalenone, trichothecenes type A (T-2 and HT-2) and trichothecenes type B (deoxynivalenol and nivalenol) were analysed by using high-performance liquid chromatography. Deoxynivalenol and zearalenone were detected in 72% and 38% of the barley samples, respectively, at levels below European Union limits in all cases. However, the co-occurrence of both toxins in 34% of the samples suggested that synergistic activity of these two mycotoxins should be evaluated. Nivalenol and HT-2/T-2 were detected at low levels in 17% and 10% of the samples, respectively. Fumonisins occurred in 34% of the samples at levels up to 300 µg/kg. This suggested that they might represent a risk in Spanish barley, and to our knowledge, this is the first report on the presence of fumonisins in barley in this country. The species-specific polymerase chain reaction assays to detect mycotoxin-producing Fusarium species showed a very consistent correlation between F. verticillioides detection and fumonisin contamination as well as F. graminearum presence and zearalenone, deoxynivalenol and nivalenol contamination in barley samples. The approach used in this study provided information of mycotoxin contamination of barley together with the identification of the fungal species responsible for their production. Detection of the species with the current polymerase chain reaction assay strategy may be considered predictive of the potential mycotoxin risk in this matrix.

Effect of preharvest anti-fungal compounds on Aspergillus steynii and A. carbonarius under fluctuating and extreme environmental conditions.

Ochratoxin A (OTA) has been found in pre-harvest and freshly harvested wheat. Spanish climatic conditions point to Aspergillus species as probably responsible for this OTA. In this study the effectiveness of 5 non-specific antifungal chemicals used on wheat fields (25.9% tebuconazole+60.0% N,N-capramide dimethyl; 12.70% tebuconazole+12.7% prothioconazole+59.5% N,N-amide dimethyldecane; 12.5% epoxiconazole; 12.5% tetraconazole; and 70% thiophanate methyl) and an extract from Equisetum arvense were investigated in vitro on wheat by recording growth (colony size, fungal growth and DNA concentration) and OTA production of two ochratoxigenic isolates of Aspergillus carbonarius and three of A. steynii, simulating current and extreme climatic conditions. Inoculated wheat was incubated under two alternating temperature cycles (20/30°C and 25/35°C) with photoperiod (14/10h lightness/darkness), and two moisture levels (40 and 25%). The Aspergillus species tested seemed to be able to persist in predicted future climatic conditions, in particular, A. steynii, a high OTA producer. Azoles were effective in controlling the growth of A. carbonarius and A. steynii, and this effectiveness may not be compromised by the increase in temperature and decrease of humidity. However, azoles are not useful for the prevention of OTA accumulation, which could be only reduced in A. carbonarius under non-extreme conditions. Although some adjustment will probably be required, further studies should be conducted in the field, since the antifungals used in this study are applied at flowering and not directly on the grain. Moreover, timing of antifungal application may need to be optimized. Finally, Equisetum extract showed promising results as an antifungal, however further work to adjust the applied concentrations is required.

Mycobiota and co-occurrence of mycotoxins in Capsicum powder.

This study aimed to: (1) determine the mycobiota of Capsicum powder samples, paying a special attention to the mycotoxigenic moulds; (2) evaluate the contamination levels of aflatoxins (AF), ochratoxin A (OTA), zearalenone (ZEA), deoxynivalenol (DON), T2 and HT2 toxins in those samples. Thirty-two samples were obtained through the methods of sampling established by the European Union legislation. Aspergillus and Eurotium were the most frequently found genera. Aspergillus section Nigri had the higher relative frequency in the samples, A. niger aggregate being the most representative group of this section. Other potentially mycotoxigenic Aspergillus, Fusarium and Penicillium species were found, but in a lower frequency. Co-occurrence of mycotoxins was confirmed in the 32 Capsicum powder samples. All samples were contaminated with AF and OTA, 27% with ZEA (36% of chilli and 18% of paprika samples), 9% with DON (18% of chilli and 6% of paprika samples), 6% with T2 (18% of chilli samples) and none of the samples contained HT2. Although in the present study the most common genera found (Aspergillus and Eurotium) belong to storage moulds, some field fungi such as Fusarium spp. were also found, and their toxins were sometimes detected. This fact supports the hypothesis that mycotoxin contamination of Capsicum products may occur both in the field and/or during storage.

Clinical efficacy and safety of primary antifungal prophylaxis with posaconazole vs itraconazole in allogeneic blood and marrow transplantation.

Posaconazole has been recently approved for primary antifungal prophylaxis in patients with prolonged neutropenia after AML induction chemotherapy and patients with GVHD. We now present the first experience of the efficacy and safety of posaconazole during the early phase of post-allogeneic BMT (n=33; from June 2007), in comparison with itraconazole primary prophylaxis (n=16; up to May 2007). More patients receiving posaconazole were T-cell depleted (P=0.003). Groups were otherwise comparable in terms of age, sex, disease, neutrophil engraftment, incidence of GVHD, use of unrelated donors and type of conditioning. Safety data as well as the incidence of fever (84%) and persistent fever (27%) during the 100-day treatment period were comparable for both antifungal agents. Patients receiving posaconazole had a lower cumulative incidence of proven or probable invasive fungal disease, as defined by the European Organization for Research and Treatment of Cancer criteria (0 vs 12%; P=0.04), which associated with a higher probability of fungal-free survival (91 vs 56%; P=0.003) and an improved probability of OS (91 vs 63%; P=0.011) compared with patients receiving itraconazole. Our single-centre experience suggests that antifungal prophylaxis with posaconazole may lead to a better outcome than itraconazole for patients in the early high-risk neutropenic period after allogeneic BMT.

Tumor de Abrikossoff: revisión de la literatura y presentación de tres casos / Abrikossoff’s tumor: literature review and report of three cases

El tumor de células granulares (TCG) es una lesión benigna einfrecuente, que se suele presentar como una masa asintomática de menosde dos centímetros de diámetro. Aunque su origen todavía permanece desconocido,se sospecha que es neural (célula de Schwann), debido a estudiosinmunohistoquímicos. Puede aparecer en cualquier parte del cuerpo,pero la región de la cabeza y el cuello es la más habitual (50%). En la cabezay cuello, la lengua es la localización más común del TCG, seguida porla piel, la laringe, y los sistemas respiratorio y digestivo.En el estudio histológico, es característica la presencia de hiperplasia pseudo-epiteliomatosa, y el epitelio superficial está preservado normalmente.El análisis inmunohistoquímico revela reacción positiva a la proteína S-100,enolasa neuronal y proteínas mielínicas como P0 y P2.Presentamos tres casos de TCG y un resumen breve de la literatura existente.El primer caso fue diagnosticado en una mujer de 36 años de edad,el segundo en un hombre de 45 años, y el tercero en otro hombre de 55años. Las lesiones estaban localizadas en el borde lateral, la superficie ventraly la superficie dorsal de la lengua. El tratamiento fue quirúrgico enlos tres casos y no hay evidencia de recurrencia del tumor después de unperíodo de seguimiento que varía desde los 8 meses a los 2 años(AU)

Granular cell tumor (GCT) is an uncommon bening lession,pressentig as an asympmtomatic mass, less than two centimetersin diameter. The origin is still unknown, althougt it’s suspected tobe neural (Schwann cell), because of immunohistochemical studies.It can appear in any part of the body, but the head and neck regionis the most common (50%). In the head and neck, the tongue is themost usual location for GCT, followed by the skin, larynx, respiratoryand digestive system. In the histological study is caracteristic thepresence of pseudo-epitheliomatous hyperplasia, and the overlyingephitelium is usually preserved. Immunohistochemical analisis revealspositive reaction to S-100 protein, neuronal enolase, mielinic proteinas P0 and P2. We present three cases of GCT of the tongue and abrief review of the literature. The first case was found in a 36 yearold woman, the second in a 45 year old man and the third one in a55 year old man. The lesions were placed in the lateral border, theventral surface and the dorsal surface of the tongue. The treatmentwas surgycal, and there was no evidence of recurrence after a periodfrom eight months to two years of follow up(AU)

Polymerase chain reaction (PCR) identification of Penicillium brevicompactum, a grape contaminant and mycophenolic acid producer.

Penicillium brevicompactum is a ubiquitous fungal species that contaminates diverse substrates and commodities and produces an array of metabolites toxic to human and animals. The present work has obtained evidence, by liquid chromatography (LC)-ion-trap mass spectrometry, of the ability of P. brevicompactum strains isolated from grapes to produce mycophenolic acid, a potent immunosuppressor. In order to facilitate early diagnosis of this species on commodities for human and animal consumption, a rapid, sensitive and specific polymerase chain reaction (PCR) assay for P. brevicompactum was developed. The specific primers were designed based on the ITS1-5.8S-ITS2ITS (Internal Transcribed Spacers of rRNA genes) multicopy region. This method provides a useful aid to detect the presence of this fungal species in grapes and other commodities in order to prevent the toxins produced entering the food chain.

[Platelet-rich plasma (platelet gel) in secondary alveoloplasty in cleft patients]. / Plasma enriquecido en plaquetas en la alveoloplastia de pacientes fisurados.

INTRODUCTION: The use of Platelet-rich plasma (platelet gel--PRP--) was introduced in the oral and maxilofacial surgery 10 years ago. Its good results are due to the quickly generation of new bone and the acceleration of the period of surgical scar formation. Its employment in the alveolar reconstruction of the cleft patient is not still consistent and the works published in the literature are infrequent. The objective of this preliminary study is presenting our experience with the use of PRP in the reconstruction of the alveolar congenital defects of cleft patients. PATIENTS AND METHODS: Between July 2002 and January 2004 were operated 14 patients with congenital alveolar cleft carrying out an standard secondary alveoloplasty. In 12 cases was employed cancellous bone of iliac crest and in two cases the donor area was tibial. The laboratory of Hematology of our Hospital prepared the plasma gel rich in platelets by means of a double centrifuge of autologous serum of the patient. After adding calcium a rich gel in platelets in approximate quantities of 1-2 ml was obtained. In this preliminary report we have studied the aspect of the surgical injury the 3er postoperative day, and the first and second weeks after intervention. These results were compared carried out previously with the Standard alveoloplasty without use of the PRP. Likewise we evaluated the bony density by means of intraoral Rx at 3 and 6 months postoperative. RESULTS: The injury of the alveoloplasty healed more quickly in the patients in which plasma enriched gel was employed. The patients referred less pain and edema in the first days of the postoperative period. The alveolar bony regeneration was faster to the 3 months, though the result was similar in the intraoral Rx to the 6 months. The necessary quantities of cancellous bone were smaller in all cases in which the plasma enriched gel was used (30% less). CONCLUSIONS: The use of Platelet-rich plasma (PRP) is a valid protocol for the reconstruction in patients with congenital alveolar clefts. Its low price and morbidity do it recommendable for its employment in cleft patients.

Plasma enriquecido en plaquetas en la alveoloplastia de pacientes fisurados / Platelet-rich plasma (platelet gel) in secondary alveoloplasty in cleft patients

Introducción. El uso de plasma autólogo enriquecido en plaquetas (PRP) fue introducido en la cirugía oral y maxilofacial hace unos 10 años. Sus buenos resultados se deben a la rapidez con la que genera nuevo hueso y la aceleración del período de cicatrización quirúrgico. Su empleo en la reconstrucción alveolar del paciente fisurado no es todavía consistente y los trabajos publicados en la literatura son muy escasos. El objetivo de este estudio preliminar es el de presentar nuestra experiencia con la utilización del plasma rico en plaquetas en la reconstrucción de las fisuras alveolares congénitas de pacientes fisurados. Material y métodos. Entre julio de 2002 y enero de 2004 fueron intervenidos 14 pacientes con fisura alveolar congénita realizando una alveoloplastia secundaria estándard. En 12 casos se empleó injerto óseo esponjoso de cresta ilíaca y en dos casos la zona dadora fue tibial. El laboratorio de Hematología de nuestro centro preparó el concentrado plasmático rico en plaquetas mediante un doble centrifugado de suero autólogo del paciente y pipeteado del mismo. Tras añadir gluconato cálcico se obtuvo un gel rico en plaquetas en cantidades aproximadas de 1-2 ml. En este estudio preliminar hemos estudiado el aspecto de la herida quirúrgica el 3er día postoperatorio, y la primera y segunda semanas de la intervención. Se compararon estos resultados con los realizados previamente en la alveoloplastia estándard sin uso del plasma rico en plaquetas. Igualmente se valoró la densidad ósea mediante Rx intraoral a los 3 y 6 meses. Resultados. La herida de la alveoloplastia cicatrizó mucho más rápidamente en los pacientes en los que se empleó plasma (..) (AU)

Introduction. The use of Platelet-rich plasma (platelet gel–PRP-) was introduced in the oral and maxilofacial surgery 10 years ago. Its good results are due to the quickly generation of new bone and the acceleration of the period of surgical scar formation. Its employment in the alveolar reconstruction of the cleft patient is not still consistent and the works published in the literature are infrequent. The objective of this preliminary study is presenting our experience with the use of PRP in the reconstruction of the alveolar congenital defects of cleft patients. Patients and methods. Between July 2002 and January 2004 were operated 14 patients with congenital alveolar cleft carrying out an standard secondary alveoloplasty. In 12 cases was employed cancellous bone of iliac crest and in two cases the donor area was tibial. The laboratory of Hematology of our Hospital prepared the plasma gel rich in platelets by means of a double centrifuge of autologous serum of the patient. After adding calcium a rich gel in platelets in approximate quantities (..) (AU)

Fumonisin production by Gibberella fujikuroi strains from Pinus species.

Fumonisins are important mycotoxins basically produced by strains from the Gibberella fujikuroi species complex (with anamorphs in Fusarium genus) which contaminate food and feed products representing a risk to human and animal health. In this work, we report for the first time the fumonisin production of Fusarium moniliforme Sheldon strains associated to edible pine nuts of Pinus pinea. P. pinea is an important and widely distributed Pinus species in the Mediterranean area where their pine nuts are consumed raw or slightly processed in diverse food products. In this work, characterization and further identification of those strains were performed by polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLPs) of the intergenic spacer region of the rDNA (IGS) with the aid of the eight mating populations (A-H) described for G. fujikuroi species complex. The method was powerful to detect polymorphism, allowing discrimination between individuals and could be used to study the genetic relationships among them and within the G. fujikuroi species complex. Fusarium strains associated to Pinus radiata were also included in the present study. These strains did not produce fumonisins and showed no close relation with the strains isolated from P. pinea. The approach used in this work was rapid and proved to be efficient to assist identification and to characterize and analyse relatedness of new isolates within the G. fujikuroi species complex.

Characterization and in vitro expression patterns of an exopolygalacturonase encoding gene from Fusarium oxysporum f.sp. radicis lycopersici.

AIMS: In this work, we report the isolation, characterization and expression pattern in in vitro cultures of an EXOPG encoding gene (pgx2), a novel EXOPG encoding gene of Fusarium oxysporum f.sp. radicis lycopersici, responsible for foot crown and root rot disease in tomato plants. The gene was compared with other fungal polygalacturonases (PGs) previously reported. METHODS AND RESULTS: Partial sequences of the purified EXOPG native protein were used to design primers that amplified a genomic fragment by PCR. The amplified genomic fragment was used as a probe to screen a genomic library. One isolated clone was analysed. The complete genomic, cDNA and the deduced amino acid sequences were compared with other fungal EXOPGs and ENDOPGs. Regulation of pgx2 expression was analysed by Northern blot in in vitro cultures supplemented with different carbon sources. CONCLUSIONS: Pgx2 was present as single copy in the haploid genome of several Fusarium species. PGX2 showed the conserved amino acid motifs typical of PGs and those reported for fungal EXOPGs. Pgx2 was regulated at transcriptional level showing similar expression pattern to other EXOPG encoding gene (pgx1) when the fungus was cultured on different carbon sources suggesting a coordinate expression of both genes. This similarity would be supported by the presence of common putative regulatory motifs in the upstream regions of both genes. SIGNIFICANCE AND IMPACT OF THE STUDY: This study reports the analysis of a novel EXOPG gene of the tomato pathogen F. oxysporum f.sp. radicis lycopersici, a contribution to the understanding of the role of cell-wall-degrading enzymes produced by fungi during pathogenesis.

[Diaphragmatic paralysis: pathology at the reach of the pediatric surgeon]. / Parálisis diafragmática: patología al alcance del cirujano pediátrico.

The phrenic nerve is the only motor nerve in the diaphragm. The injury will lead to a diaphragmatic paralysis or eventration with paradoxical movements during breathing. The aim of this review is to analyze the diagnostic criteria, surgical indications, and the patients that are not treated by surgery. We review 53 cases with diaphragmatic pathology in the last 5 years; 19 females and 20 males. One was a diaphragmatic rupture, 13 were diaphragmatic hernias, and 39 had diaphragmatic paralysis. Diaphragmatic paralysis was diagnosed by fluoroscopy in 97%, electromiography 5.1% or ultrasounds. The ethiology was 64% after cardiac surgery and 10% after thoracic oncologic surgery. The age at diagnosis was less than 1 month in 41% cases. In 29 patients the paralysis was well tolerated and were extubated between 24 h and 4 days after the diagnosis, frequently was in the first 48 h. 4 patients need a traqueostomy and 2 went to another hospital. In 5 we performed a diaphragmatic plication because the inability to be extubated or the persistence of respiratory distress. The paralysis was demonstrated by fluoroscopy. 2 patients are asymptomatic, 2 are in mechanical ventilation and 1 died (sepsis). The most frequent cause of diaphragmatic paralysis was related to cardiac or thoracic surgery. In general, is well tolerated, almost asymptomatic, the patients were extubated between 24 or 48 h. In pediatric population they are few cases that need surgical treatment. The patients that we operated on were less than 2 months old, because is at that age were the repercussion is more important. We must follow strict criteria, without precipìtation for the surgical indications.

Parálisis diafragmática: patología al alcance del cirujano pediátrico / Diaphragmatic paralysis: pathology on the pediatric surgeon hands

El nervio frénico es el único motor que inerva el diafragma, su lesión produce parálisis diafragmática o eventración con movimientos paradójicos durante la respiración. El objetivo de nuestro trabajo es analizar los criterios diagnósticos, las indicaciones quirúrgicas, la técnica utilizada, el tiempo en que se Ileva a cabo la cirugía y los resultados, valorando también los pacientes que no han sido intervenidos.Para ello revisamos 53 pacientes diagnosticados de patología del diafragma en los últimos 5 años. De ellos, 1 caso de rotura traumática, 13 hernias diafragmáticas, y 39 con parálisis o eventración diafragmática. Centramos el estudio en estos últimos que fueron diagnosticados mediante escopia en 97 por ciento de los casos, electromiograma 5,1 por ciento, o ecografía. La etiología de las eventraciones fue en 64 por ciento tras cirugía cardiaca y un 10 por ciento tras cirugía torácica oncológica. La edad al diagnóstico era de menos de un mes en el 41 por ciento casos. En 29 pacientes la parálisis diafragmática fue bien tolerada y fueron extubados entre 24 h y 4 días del diagnóstico. Cuatro pacientes requirieron traqueostomía debido a la intubación prolongada y 2 se trasladaron intubados a otro hospital. En 5 pacientes se practicó una plicatura diafragmática quirúrgica indicada ante la imposibilidad de extubación, o la persistencia de distress respiratorio al intentarlo, siendo demostrada la parálisis por escopia. De estos 1falleció por sepsis, 2 permanecen con ventilación mecánica y 2 están asintomáticos.La causa más frecuente de parálisis diafragmática está relacionada con la cirugía cardiaca o mediastínica. En general son bien toleradas, casi asintomáticas, se diagnostican fundamentalmente por escopia y permiten la extubación en un plazo de 24- 48 horas. En nuestro medio es raro que precisen de tratamiento quirúrgico. Los pacientes operados tenían menos de 2 meses de edad ya que es en la etapa neonatal donde tienen más repercusión respiratoria. Deben seguirse criterios estrictos, sin precipitarse para indicar la cirugía (AU)

Quemaduras en la infancia. Trascendencia social a las puertas del 2000 / Childiiood burns. Social transcendence at the doors of 2000

Las lesiones térmicas en la infancia son la tercera causa de morbilidad hospitalaria en nuestro entorno. El conocimiento de la incidencia, los agentes causales más frecuentes, y el análisis detallado de las distintas variantes en torno al tema, constituyen la única manera de intentar establecer medidas para prevenirlos. El objetivo de nuestro trabajo es analizar los factores y situaciones asociados a accidentes térmicos, mediante el estudio retrospectivo de los pacientes ingresados. Material y métodos. En nuestro centro, durante un período de tres años fueron ingresados 362 niños entre 0 y 14 años que reunían los criterios siguientes: superficie quemada de más del 10 por ciento, localización crítica (manos, cara, cuello, zonas de flexión), agente causal (electricidad, químico) o situación social. Se han analizado datos referentes a la procedencia, el lugar del accidente, agente causal, parte del cuerpo lesionada, grado de lesión, y estancia media de hospitalización. Resultados. Los niños son el 59,6 por ciento de los ingresados frente a 40,3 por ciento niñas; siendo la edad de más riesgo entre los I y 5 años, 205 casos. El 66 por ciento de ellos era remitido de otro hospital o centro de salud donde se les hizo la primera cura. El 98,7 por ciento se había quemado en casa, siendo el lugar más frecuente la cocina, 51 por ciento. El agente causal en el 65,4 por ciento eran líquidos, especialmente agua caliente, hasta en 104 casos. Las zonas más afectadas son la cara (39,2 por ciento) y las extremidades superiores, siendo en 81 por ciento de segundo grado superficial o profundo. La extensión era de un 10 al 20 por ciento en el 19 por ciento de los pacientes, y con una superficie superior al 40 por ciento en el 0,2 por ciento de los niños. La estancia media de estos 362 niños fue de 17,47 días en nuestro hospital. Conclusiones. La mayoría de los accidentes ocurren en el domicilio, en concreto en la cocina, con líquido caliente, y en niños entre 1 y 5 años de edad. Evitando este mecanismo reduciríamos drásticamente las cifras de estos accidentes. Medidas simples, pero efectivas, como sujetar las cocinas, evitar el acceso a los microondas y tapas de hornos, protección de enchufes, así como fomentar la educación continuada en la prevención e importancia de este tipo de lesiones y sus secuelas es sin duda tarea obligada de nuestra Sociedad Española de Cirugía Pediátrica (AU)