Ingestión de 208 cuerpos extraños en niños: enero 2004 - abril 2009 / Ingestion of 208 foreign bodies in children: January 2004 - April 2009

Introducción: La ingesta de cuerpo extraño representa la segunda causa de urgencia endoscópica en niños. Objetivo: Evaluar nuestra experiencia en niños con ingesta de cuerpo extraño: sexo, edad, tipo, conducta y complicaciones. Pacientes y métodos: Se realizó un estudio retrospectivo longitudinal a 208 niños hospitalizados por esta etiología desde Enero de 2004 hasta Abril de 2009 en Hospital Universitario Dr. "Luis Razetti", Barcelona. A todos se les realizó Radiografías de cervical, tórax y abdomen. Resultados: Predominaron: masculinos (55,77%), y preescolares (70,67%). Los objetos más frecuentes fueron: moneda (164/208), zarcillo (6/208), pinza de cabello, pila de reloj, semilla 4/208 en cada uno. Con respecto a los procedimientos: 1. Endoscopia: (177/208), de estos 166 se encontraron en esófago (93,37% en 1/3 superior), 130 se extrajo el objeto con pinza, 40 se le desplazó a estómago y 5 no se encontraron. Se evidenció lesión de mucosa a 43 y a 3/177 estenosis esofágica; dos ameritaron cirugía. 2. Laringoscopia: (4/208) y 3. Broncoscopia (2/208): un imperdible en bronquio derecho y una semilla en bronquio izquierdo. 4. Expulsión natural por heces (25/208). Conclusión: La ingesta de cuerpo extraño está entre las primeras causas de los accidentes en los niños, amerita un diagnóstico e intervención precoz.

Introduction: Intake of foreign bodies represents the second cause endoscopic emergency in children. Objectives: Evaluate our experience with children in foreign body intake: sex, age, type, conduct and complications. Patients and methods: A retrospective longitudinal study in 208 children hospitalized for this etiology since January 2004 until April 2009 at Dr. "Luis Razetti", Barcelona University Hospital. All underwent cervical, thoracic and abdominal radiographs. Results: prevailed: male (55.77%), and pre-school (70.67%). Objects frequently found were: currency (164/208), earring (6/208), hairclip, clock battery, seed 4/208 in each. With concerning the procedures: 1. Endoscopy: (177/208), of these 166 were found in the esophagus (93.37% in 1/3 superior), 130 extracted the object with clamp, 40 were displaced to the stomach and 5 were not found. Mucosal injury was found to 43 and in 3/177 esophageal stenosis, two requierd surgery. 2. Laringoscopy: (4/208) and 3. Bronchroscopy (2/208): a safety pin in the right bronchus and a seed in left bronchus. 4. Natural expulsion by feces (25/208). Conclusion: foreign body intake is among the primary causes of accidents in children, deserves a diagnosis and precocious intervention.

Tumor vaccines--application to childhood cancer.

Currently, several clinical studies explore the therapeutic potential of tumor vaccines which are genetically modified to produce immunostimulatory molecules as a complementary approach for conventional cancer therapy. In this review the immunological basis and the preclinical design of such vaccine strategies are described with particular emphasis to acute leukemia and neuroblastoma. The role of cytokines, chemokines and costimulatory surface molecules for generation of tumor vaccines is summarized, and the advantages and disadvantages of autologous, allogenic and dendritic cell vaccines are discussed. Finally, combination-immunogens are introduced as a potent means of enhancing the anti-tumor response.

Analysis of the polymerization kinetics of homodimeric EIAV p51/51 reverse transcriptase implies the formation of a polymerase active site identical to heterodimeric EIAV p66/51 reverse transcriptase.

Homodimeric EIAV p51/51 and heterodimeric EIAV p66/51 reverse transcriptase were purified in order to compare the different modes of DNA synthesis supported by the enzymes. Analysis of the dimerization behavior of the EIAV enzymes indicates that the dimer stability of EIAV reverse transcriptase enzymes is higher than that of their HIV-1 reverse transcriptase counterparts. EIAV p51/51 polymerizes DNA distributively whereas DNA synthesis by EIAV p66/51 is processive. Steady-state and pre-steady-state kinetic analyses of primer/template binding and nucleotide incorporation were performed with both enzymes to determine the reasons for the different polymerization behavior. Equilibrium fluorescence titrations demonstrated that the Kd values of EIAV p51/51 for binding of DNA/DNA and DNA/RNA substrates are increased 10-fold and 28-fold, respectively, as compared to EIAV p66/51. Stopped-flow measurements with DNA/DNA show that the increase in the Kd is in part due to a 17. 4-fold higher dissociation rate constant (k-1) for EIAV p51/51. Additionally, with EIAV p51/51, kdiss is increased 7-fold for DNA/DNA and 14-fold for DNA/RNA primer/template substrates, respectively. The lack of the RNase H domain in EIAV p51/51 leads to differences in the pre-steady-state kinetics of nucleotide incorporation on DNA/DNA and DNA/RNA templates. The burst of both enzymes is composed of two phases for both substrates, and the values for the corresponding pre-steady-state burst rates, kpol1 and kpol2, are similar for both enzymes, implying the formation of identical polymerase active sites. However, the amplitudes of the two phases differ with DNA/DNA templates, indicating a different distribution between two states varying greatly in their kinetic competence.

Near-miss sudden infant death syndrome in eight infants with sleep apnea-related cardiac arrhythmias.

Eight full-term infants between 3 and 8 weeks of age, who had had 24 to 48 hours of vague problems involving a congested upper airway and/or irritability, had a life-threatening respiratory episode at home, called a near-miss for sudden infant death syndrome event. Polygraphically monitored mixed apneas occurred in clusters during non-rapid eye movement (NREM) sleep with significant cardiac arrhythmias, predominantly sinus arrest. The cardiorespiratory problems continued during sleep in the following 8 to 12 weeks but did not recur after that time, and there were no long-term sequelae when the children were studied again 4 to 7 years later.

Five cases of near-miss sudden infant death syndrome and development of obstructive sleep apnea syndrome.

Five full-term infants were referred for "near miss" sudden infant death syndrome events, which occurred between 3 and 12 weeks of age. After a complete pediatric evaluation and 24-hour polygraphic monitoring, each infant was monitored at home with a cardiorespiratory monitor. Each was followed regularly (with repeat polygraphic recordings) up to 4 years of age. All five infants developed heavy snoring at night and symptoms of obstructive sleep apnea syndrome. The diagnosis of obstructive sleep apnea syndrome was confirmed by polygraphic recordings; surgery was recommended. Four of the five children underwent adenoidectomies between 3 and 4 years of age, and this significantly improved their condition. These five cases are the first polygraphically documented histories of the development of obstructive sleep apnea syndrome.

Abnormal polygraphic findings in near-miss sudden infant death.

Sleep, respiratory, and cardiac data obtained during sleep and wakefulness by continuous 24-hour polygraphic monitoring from twelve infants who were "near misses" for the sudden-infant-death syndrome were compared with similar information obtained from seven low-risk infants. Although the sleep variables studied were of limited value in differentiating between the low and high risk patients, respiratory and cardiac abnormalities were strikingly more common in near-miss infants. High-risk infants demonstrated both obstructive and mixed stopped-breathing episodes (S.B.E.). Bradycardia was seen secondary to S.B.E. but also simultaneously with or independent of S.B.E. Sudden asystole associated with S.B.E. was seen in one case. These results suggest an autonomic-nervous-system dysfunction in high-risk infants.

Apneas during sleep in infants: possible relationship with sudden infant death syndrome.

Several types of apnea are described in premature infants and in infants who have survived breathing-stoppage episodes which may be related to the sudden infant death syndrome. Upper airway apnea appears to induce the greatest changes: oxygen desaturation is more pronounced than in a central apnea of similar duration, and secondary cardiac changes are observed earlier and are more severe.