Timing of ondansetron administration to prevent postoperative nausea and vomiting

BACKGROUND: The original guidelines for using ondansetron recommending its administration prior to induction of anesthesia have been questioned. METHOD: In an effort to determine the most effective timing of ondansetron administration to prevent postoperative nausea and vomiting (PONV), a prospective, randomized, double-blind study was performed. Patients undergoing ambulatory plastic surgery procedures estimated to last two hours or more and who had at least two risk factors for PONV (female gender, non-smoker, previous history of PONV and postoperative opioids) participated in the study. General anesthesia for all patients followed the same standard institutional protocol and all patients received dexamethasone 4 mg intravenously at the start of surgery. The control group (n = 188) received 4 mg of ondansetron intravenously prior to the induction of anesthesia. The study group (n = 184) received 4 mg of ondansetron intravenously 30 minutes prior to completion of the surgery. The incidence of PONV during the early (0-2 hours) and delayed (2-24 hours) postoperative periods was recorded. RESULTS: No significant difference was found between the groups regarding early postoperative nausea or vomiting (p > 0.05). However, a significant difference (p < 0.05) was noted in both late postoperative nausea (control: 30% vs. study group: 20%) and late postoperative vomiting (control: 17% vs. study group: 8%). CONCLUSION: This clinical study indicates that when performing prolonged surgical procedures, late administration of ondansetron (within 30 minutes prior to completing the surgery) is significantly more effective in the prevention of late PONV than when administered prior to the induction of anesthesia.

[Funicular torsion with testicular necrosis in the newborn]. / Torsión funicular con necrosis testicular en el recién nacido.

Three cases of extravaginal torsion of the spermatic cord with infarct of the testicle in the newborn are presented. All three cases had acute fetal distress. They had in common being the products of multiparous women, born in a distocic fashion with a prolonged labor without prenatal control. One of the had a shoulder impaction with required forceps use. Two of them were delivered on vaginal way and the other one by cesarean section. In all three cases, torsion was present at birth. Diagnosis was made between third and fifth day of life; the clinical findings were: enlargement of the right scrotal bag, purple discoloration of the skin, a painless hard mass that did not permit the passage of light (transillumination) and the absence of cremasteric reflex. A right resolution ultrasound was useful in determining the inflammatory tumoral mass. A right orchidectomy and pexy of the contralateral testicle were done in the three cases with nonabsorbable sutures and no testicular implants. The following diagnoses should be discarded prior to a definitive diagnosis: scrotal edemas, hydrohematocele, strangled inguinal hernia with infarct and testicular neoplasia.

[Congenital atresia of the vagina]. / Atresia congénita de vagina.

The articles includes eight cases of congenital atresia of the vagina seen and studied at the Pediatric Surgery Department. All cases were congenital five of them corresponded to the Mayer-Rokitansky-Kuster-Hauser Syndrome an the remaining three to congenital adrenal hyperplasia. No other malformations were associated to any of the cases. The karyotype, hormones and secondary sexual characteristics were normal in those cases of Mayer-Rokitansky-Kuster-Hauser Syndrome. In the other three cases of congenital adrenal hyperplasia the karyotype was found to be 46XX, the 17-ketosteroids and pregnanediol were high and the patients were found to have hirsutism and were virilized. The ultrasonography, CAT and magnetic resonance scans showed excellent anatomical information on the congenital vaginal atresia and the intrapelvic organs. No other invasive study was needed to confirm its existence. Six of the patients were operated using the McIndoe and Bannister technique while on the other two the Tobin and Day technique was used. Post-surgical complications included vaginal stenosis in two cases within the first three months. The article includes an analysis of the complications and both the anatomical and functional results obtained.

[Total denudation of the penis in circumcision. Description of a plastic technique for repair of the penis]. / Denudación total del pene por circuncisión. Descripción de una técnica de plastía del pene para su corrección.

The difficulty of knowing the percentage of newborns and infants who have been circumcised in our medium, and the presence in the Surgical Pediatric Ward of our hospital, during the last five years, of patients with total denudation of the penis--secondary to a circumcision with plastibel, drove us to research and share our experience in the use of a free skin graft for its correction, the postoperative care needed and the follow-up of those patients. Circumcision is a surgical procedure which is not totally innocuous and which should be performed by surgically experienced personnel to obtain good results. It is recommended that general practitioners and pediatricians be informed that the denudation of the penis is an infrequent but severe complication, and how to avoid its occurrence. Complications of plastibel circumcision in pediatrics.

Borderline disorders of childhood: an overview.

This selected review considers children classified as "borderline" and focuses on two broad categories: Borderline personality disorder/borderline spectrum and schizotypal personality disorder/autism/schizophrenia spectrum classifications. Clinical descriptions, biological correlated, delimitation from other disorders, outcome, family studies, hypothesized etiologies, therapeutic considerations, and response to treatment are presented for each. Data support the subclassification of the heterogeneous groupings of borderline children into at least the two categories, and their differentiation from each other and from other clinical disorders in the population. Overlap across the borderline categories exists for individual children. The nature and shortcomings of relevant studies are described, the need for scientifically based research championed, and a differential approach to directive treatment of borderline children advocated. Further subclassification of borderline disorders should result in more cost-effective diagnosis and treatment.

[Tumor markers used in oncology]. / Marcadores tumorales empleados en oncología.

The most useful markers, include human chorionic gonadotropin (hCG), alpha-feto protein (AFP), and carcinoembryonic antigen (CEA). The major utility of those would be in monitoring patients with choriocarcinoma, the germ cell tumors, and gastrointestinal neoplasm. Tumors Markers have not been so successful in the early detection of neoplasm in the general population. Possible explanation will be the lack of specificity for tumors as opposed to normal tissue. Monoclonal antibodies to human tumors cell can be prepared using hybridization techniques. These antibodies are homogenoous, recognize specific antigenic determinants with high affinities, and can be mass produced. Monoclonal antibodies detect qualitative and quantitative differences in the antigenic composition of normal and malignant cells. Have important clinical application in the detection and early diagnosis of cancer, in accurate tumor staging, and in therapy.

Hernioplastia inguinal con la tecnica de Mitchell-Bank. / Inguinal hernioplasty with Mitchell-Banks' technic

Los autores presentan 147 casos operados con la tecnica de Mitchell-Banks que esta basada en la diseccion del saco herniano que se liga y secciona dentro del canal sin descubrir esta estructura. En su estudio, ellos incluyeron pacientes desde recien nacidos hasta ninos de 12 anos, quienes, en algunos casos, presentaban hidroceles y grandes sacos herniarios. No se reportaron recurrencias y hubo incidencias minimas de complicaciones. Se afirma que esta tecnica es simple, menos traumatica y rapida a causa de las pocas estructuras a disecar y el no tener que descubrir el canal, lo que ahorra tiempo y traumatismo a la region