Hidatidosis hepática / Hepatic hydatidosis

La hidatidosis sigue causando una importante morbimortalidad en diversas partes del mundo. El diagnóstico definitivo de la afectación hepática depende de la combinación de técnicas de imagen y estudios serológicos. El tratamiento de elección continúa siendo la cirugía, especialmente en quistes de gran tamaño o complicados. Presentamos el caso clínico de un paciente de 5 años, a quien se detecta en una exploración rutinaria una masa abdominal localizada en el hipocondrio derecho. Había estado en contacto con un perro que estaba correctamente desparasitado. Mediante ecografía y resonancia magnética nuclear abdominales se diagnostica un quiste hepático de 11 cm de diámetro. La serología confirma la etiología, ya que presenta título de anticuerpos frente a Echinococcus de 1/128. Dado el tamaño del quiste, se opta por un tratamiento quirúrgico mediante quistectomía. Tanto el estudio del líquido quístico (se observan Echinococcus granulosus) como la histología de la pieza quirúrgica son diagnósticas de quiste hidatídico. La evolución clínica de la paciente fue satisfactoria, negativizándose los anticuerpos frente a Echinococcus al año de seguimiento(AU)

Hydatidosis continues to be an important cause of morbimortality in several parts of the world. The definitive diagnosis of the hepatic disease depends on the combination of imaging techniques and serological studies. Surgery continues to be the preferred treatment, especially in the case of large or complicated cysts. We present the clinical case of a 5-year-old patient in whom, during a routine examination, an abdominal mass located in the right hypochondrium was found. The patient had been in contact with a dog that was properly de wormed. Through an ultrasound scan and abdominal NMR imaging a hepatic cyst measuring 11 cm in diameter was diagnosed. The serology confirms the etiology since it shows a titre of antibodies against Echinococcus of 1/128. In view of the size of the cyst the chosen treatment was surgery consisting of a cystectomy. Both the study of the cystic fluid (Echinococcus granulosus are seen) as well as the histology of the surgical specimen are diagnostic of a hydatid cyst. The patient’s clinical evolution was satisfactory, with the antibodies against Echinococcus becoming negative after the patient had been followed up for a year(AU)

Manejo de la vía aérea en un lactante con síndrome de Apert / Airway management in an infant with Apert's syndrome

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[Intraoperative infiltration of 0.5% bupivacaine in pediatric tonsillectomy]. / Infiltración intraoperatoria de bupivacaína 0.5% en la amigdalectomía pediátrica.

Twenty-eight healthy pediatric patients scheduled for bilateral tonsillectomy under general anesthesia were allocated randomly into two groups. The same anesthetic technique was used in both groups. After oral intubation, tonsils were infiltrated with either 0.5% bupivacaine (group B) or isotonic saline solution (group F). During surgery, hemodynamic stability, blood loss, and need for additional anesthesia were evaluated. After surgery, hemodynamic stability, pain, general behavior, need for analgesics, oral intake, and complications were evaluated. The bupivacaine group had significantly less bleeding in the first tonsil, less need for anesthetics, and less pain in the first eight hours after surgery. None of the other variables showed statistically significant differences. These results suggest that preoperative infiltration of the tonsils with bupivacaine was useful for reducing bleeding and intraoperative anesthesia requirements, and that it reduced pain in the immediate postoperative period.

[Application of the laryngeal mask in pediatric anesthesiology]. / Aplicación de la mascarilla laríngea en anestesia pediátrica.

To analyze problems with inserting, maintaining and removing a laryngeal mask in children, as well as to assess the possible involvement of certain factors (experience with the laryngeal mask, type of anesthesia, duration of surgery, type of surgery, obesity, etc.) in favoring the development of complications. One hundred eighty-nine children undergoing a variety of surgical procedures under general anesthesia were studied; patients with full stomachs and/or a history of hiatus hernia were excluded. The agent used for anesthetic induction and the method of ventilation were chosen by the anesthesiologist responsible for each case. Variables monitored in all patients were continuous ECG, heart rate, systolic and diastolic arterial pressure, capnography, pulse oximetry, airways pressure and respiratory rate. Values were recorded at five times: before induction (T1), immediately after induction (T2), after placement of the laryngeal mask (T3), before removing the laryngeal mask (T4) and after removing the laryngeal mask (T5). Correct insertion was achieved on the first try in 85%. The remaining 15% required 2 or more tries. There were no cases in which a tracheal tube or face mask were required. We found no correlation between type or duration of surgery and the occurrence of complications. Complications were more frequent when the laryngeal mask was placed by inexperienced personnel, when inhalational anesthetics were used for induction and maintenance, and when a No. 1 laryngeal mask was used. Adequate ventilation was provided for the patients who required it with an airways pressure between 8 and 18 cmH2O, arterial oxygen saturation over 98% and end-expiratory CO2 pressure under 35 mmHg. Cardiovascular repercussions were slight and hemodynamic stability was good.(ABSTRACT TRUNCATED AT 250 WORDS)