Dispositivos intravasculares centrales de inserción subcutánea en el paciente oncológico pediátrico, ¿podemos minimizar su infección? / Subcutaneously inserted central intravascular devices in the pediatric oncology patient: can we minimize their infection

Los dispositivos intravasculares centrales de implantación subcutánea(DICIS) son utilizados frecuentemente en pacientes pediátricos. Su principal complicación es la infección, que puede requerir su retirada. El objetivo de nuestro trabajo es estudiar los factores de riesgo relacionados con su infección y retirada. Estudio retrospectivo de 120 pacientes oncológicos en los que se implantó un DICIS entre los años 2003-2009. Estudiamos factores epidemiológicos, quirúrgicos, clínicos y microbiológicos. Realizamos un análisis comparativo entre: grupo A, pacientes que presentaron infección, grupo B, el resto. El grupo A se dividió en subgrupos: infección precoz(primer mes postimplantación)/tardía, retirados/no retirados. Los datos fueron analizados mediante el programa estadístico SPSS. De 120 niños, 29 sufrían leucemia,19 linfoma y 72 tumor sólido. Un31% presentaron infección (grupo A), siendo precoz en un 36%. Un 16%de los dispositivos infectados requirió retirada. Analizando los factores relacionados con la infección se encontró diferencia estadísticamente significativa en la edad (p=0,015) y en el hecho de recibir quimioterapia previa a la implantación (p=0,034). El resto de parámetros analizados no arrojaron resultados significativos, si bien es cierto que se observó una tendencia a ésta en los pacientes con diagnóstico de leucemia, en los portadores de vía subclavia, en los que el dispositivo se colocó através de una guía sobre una vía central previa y en los trasplantados. En (..) (AU)

Long-term indwelling central venous access devices are frequently used in pediatric patients. Their main complication is infection, that can even mean their removal. We try to identify the risk factors really involved in this complication and in their removal. We have made a retrospective review of 120 oncologic pediatric patients who received a central venous device between 2003 and 2009. We searched for epidemiologic, clinic, microbiologic and surgical risk factors. We made a comparative data analysis among: GROUP A, children who suffered device infection, GROUP B the others. Group A was divided into early infection (first month after implantation) / late infection, removed /not removed. Data were analized with statistical program SPSS.29 suffered from leukemia, 19 from lymphoma and the main part,72, from solid tumour. 31% experienced infection (GROUP A), being early in the 36% of them. 16% had to be withdrawn. Data analysis revealed statistical association with the age (p=0.015) and with the reception of chemiotherapic treatment the week before the surgical insertion. The rest of the studied factors did not revealed a real association, but (..)(AU)

[Subcutaneously inserted central intravascular devices in the pediatric oncology patient: can we minimize their infection]. / Dispositivos intravasculares centrales de inserción subcutánea en el paciente oncológico pediátrico, ¿podemos minimizar su infección?

Long-term indwelling central venous access devices are frequently used in pediatric patients. Their main complication is infection, that can even mean their removal. We try to identify the risk factors really involved in this complication and in their removal. We have made a retrospective review of 120 oncologic pediatric patients who received a central venous device between 2003 and 2009. We searched for epidemiologic, clinic, microbiologic and surgical risk factors. We made a comparative data analysis among: GROUP A, children who suffered device infection, GROUP B the others. Group A was divided into early infection (first month after implantation)/late infection, removed/not removed. Data were analized with statistical program SPSS. 29 suffered from leukemia, 19 from lymphoma and the main part, 72, from solid tumour. 31% experienced infection (GROUP A), being early in the 36% of them. 16% had to be withdrawn. Data analysis revealed statistical association with the age (p=0.015) and with the reception of chemiotherapic treatment the week before the surgical insertion. The rest of the studied factors did not revealed a real association, but could be guess a relationship among infection and leukemia, subclavian catheters, those patients whose deviced was introduced using a guide over a previous catheter and also transplanted. Related to early infection the only associateon founded was with the subclavian access (p=0.018). In conclusion, in our serie long-term central venous access infection was more frequent in the younger patients and also in those who had received chemotherapy the week before the catheter implantation. The tendency towards infection in leukemia, transplanted and subclavian carriers has to be studied in a prospective way with a larger number of oncologic children.

Effect of bone size, not density, on the stiffness of the proximal part of normal and osteoporotic human femora.

Proximal femur fractures in the elderly lead to a high rate of hospitalization. In studying the operative treatment of such fractures, it is first necessary to understand the relationship between the morphologic properties of this part of the femur (related to both geometry and density) and its mechanical properties. Numerous investigations showed that femoral strength correlates with bone mass; however, the dimension of the bones was not taken into account. We measured the relationship between the stiffness of the proximal femur under physiologic load and its geometry and density. Conventional x-rays and quantitative computed tomography (QCT) were carried out on pairs of human cadaver femora. Eight pairs were instrumented with strain gauges. Bones were subjected to an eccentric load that simulates moderate weight bearing (single-leg stance), and the strain parallel to the bone axis was plotted as a function of the load applied. An apparent bone stiffness was calculated as the ratio between the strain gradient within the section and the load applied. Strong correlation was found between x-ray densitometry and QCT. The bone stiffness also correlates strongly with the geometry (area) and slightly with bone mass; however, an unexpectedly low correlation was found between stiffness and density. We chose stiffness as a mechanical parameter (not strength) because it describes the "normal" bone behavior under load. Our results clearly demonstrate that the cross-sectional size of the bones must be taken into account when establishing the relationship between the mechanical characteristics of the bone and its morphology. In accordance with previous predictions, our results support that bone loss due to osteoporosis is compensated for by an increase in bone diameter.