[Antenatal ultrasound diagnosis and neonatal results of the congenital cystic adenomatoid malformation of the lung]. / Diagnóstico ecográfico prenatal y resultados neonatales de la malformación adenomatoidea quística pulmonar.

INTRODUCTION: Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung di sease, and in the most of cases, prenatal diagnosis is feasible. There are discrepancies regarding pre natal management and postpartum treatment. OBJECTIVE: To analyze prenatally diagnosed CCAM in our hospitals, in order to evaluate ultrasound findings with fetal and postnatal evolution. PATIENTS AND METHOD: Retrospective study of all cases diagnosed prenatally by ultrasound between 2005 and 2016 in two reference hospitals. The ultrasounds were performed using high-resolution ultrasound scanners, Toshiba Xario and Voluson 730 Expert Pro, with follow-up from diagnosis to delivery. The variables analyzed included gestational age at diagnosis, the characteristics of the lung lesion, associated malformations, cytogenetic study, the evolution of pregnancy, type of delivery, presence of respiratory distress, need for complementary imaging tests, pediatric clinical course, and necessary postnatal treatments. It was considered a resolution the total disappearance of the lesion in the pre natal ultrasound or that the postnatal chest X-ray showed no lesion. RESULTS: 17 cases were prenatally diagnosed. The evolution ranges from the prenatal resolution of the lesion to the persistence after bir th. Three patients voluntarily decided to have an abortion due to ultrasound findings of poor progno sis. Of the fourteen remaining cases there were no cases of fetal or neonatal deaths, one case required surgery after birth and four patients had mild symptoms during the first year of life. One case of false negative with neonatal death has been reported which necropsy reported as CCAM type 0. Conclu sions: This pulmonary malformation presents good prognosis, excluding cases with fetal hydrops. Two-dimensional ultrasound is usually enough for diagnosis and follow-up. Computed tomography is the technique of choice to confirm the resolution of lesions after birth. Surgical treatment is pre ferable over conservative management, although it is unknown if the potential complications of this disease, even when asymptomatic, justify surgical morbidity.

Diagnóstico ecográfico prenatal y resultados neonatales de la malformación adenomatoidea quística pulmonar / Antenatal ultrasound diagnosis and neonatal results of the congenital cystic adenomatoid malformation of the lung

INTRODUCCIÓN: La malformación adenomatoidea quística (MAQ) es una patología congénita del pulmón poco frecuente y su diagnóstico prenatal es factible en la mayoría de los casos. Existen discrepancias en cuanto al manejo prenatal y tratamiento postparto. OBJETIVO: Analizar una serie de casos de MAQ diagnosticados prenatalmente, evaluando los hallazgos ecográficos y la evolución fetal y post natal. PACIENTES Y MÉTODO: Estudio retrospectivo de todos los casos diagnosticados prenatalmente por ecografìa entre 2005 y 2016 en dos hospitales de referencia. Los exámenes de ultrasonido fueron realizados utilizando ecógrafos de alta resolución, Toshiba Xario y Voluson 730 Expert Pro, con seguimiento desde el diagnóstico hasta el parto. Las variables analizadas incluyeron la edad gestacional en el momento del diagnóstico, las características de la lesión pulmonar, las malformaciones asocia das, el estudio citogenético, la evolución del embarazo, el tipo de parto, presencia de distrés respira torio, necesidad de pruebas de imagen complementarias, evolución clínica pediátrica y tratamientos postnatales necesarios. Se consideró resolución la desaparición total de la lesión ecográfica prenatal o que la radiografía torácica postnatal no mostrara lesión alguna. RESULTADOS: Se identificaron pre natalmente 17 casos. La evolución varía desde la resolución prenatal de la lesión hasta la persistencia de la misma tras el nacimiento. Tres pacientes decidieron abortar voluntariamente por hallazgos ecográficos de mal pronóstico. De los catorce casos restantes no hubo ningún caso de muerte fetal ni neonatal, un caso requirió cirugía tras el nacimiento y cuatro pacientes presentaron sintomatología leve durante el primer año de vida. Se ha reportado un caso de falso negativo con muerte neonatal, que la necropsia informó como MAQ tipo 0. CONCLUSIONES: Esta malformación pulmonar presenta buen pronóstico, excluyendo los casos con hidrops fetal. La ecografía bidimensional suele ser suficiente para el diagnóstico y el seguimiento. La tomografía computarizada es la técnica de elección para confirmar la resolución de las lesiones tras el nacimiento. El tratamiento quirúrgico es preferible sobre el manejo conservador, aunque se desconoce si las complicaciones potenciales de esta patología, aun siendo asintomática, justifican la morbilidad quirúrgica.

INTRODUCTION: Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung di sease, and in the most of cases, prenatal diagnosis is feasible. There are discrepancies regarding pre natal management and postpartum treatment. OBJECTIVE: To analyze prenatally diagnosed CCAM in our hospitals, in order to evaluate ultrasound findings with fetal and postnatal evolution. PATIENTS AND METHOD: Retrospective study of all cases diagnosed prenatally by ultrasound between 2005 and 2016 in two reference hospitals. The ultrasounds were performed using high-resolution ultrasound scanners, Toshiba Xario and Voluson 730 Expert Pro, with follow-up from diagnosis to delivery. The variables analyzed included gestational age at diagnosis, the characteristics of the lung lesion, associated malformations, cytogenetic study, the evolution of pregnancy, type of delivery, presence of respiratory distress, need for complementary imaging tests, pediatric clinical course, and necessary postnatal treatments. It was considered a resolution the total disappearance of the lesion in the pre natal ultrasound or that the postnatal chest X-ray showed no lesion. RESULTS: 17 cases were prenatally diagnosed. The evolution ranges from the prenatal resolution of the lesion to the persistence after bir th. Three patients voluntarily decided to have an abortion due to ultrasound findings of poor progno sis. Of the fourteen remaining cases there were no cases of fetal or neonatal deaths, one case required surgery after birth and four patients had mild symptoms during the first year of life. One case of false negative with neonatal death has been reported which necropsy reported as CCAM type 0. CONCLUSIONS: This pulmonary malformation presents good prognosis, excluding cases with fetal hydrops. Two-dimensional ultrasound is usually enough for diagnosis and follow-up. Computed tomography is the technique of choice to confirm the resolution of lesions after birth. Surgical treatment is pre ferable over conservative management, although it is unknown if the potential complications of this disease, even when asymptomatic, justify surgical morbidity.

Evolución y aspectos ecográficos del desprendimiento crónico de placenta / Evolution and ultrasound aspects of chronic placental abruption

El desprendimiento crónico de placenta se caracteriza por la aparición de un sangrado venoso crónico intra o retroplacentario que produce la separación paulatina de la misma. Es poco frecuente y se puede presentar en pacientes sin factores de riesgo. La imagen ecográfica plantea diagnóstico diferencial con la corioamnionitis. El pronóstico fetal es malo especialmente si se asocia con oligoamnios. Se presentan cuatro casos caracterizados por imagen ecográfica característica, retraso del crecimiento fetal, alteración del Doppler, y confirmación anatomopatológica.

Chronic placental abruption is due to intra or retroplacental insidious bleeding that causes progressive separation from the uterine wall. It is a rare condition and can occur in low risk patients. Chronic abruption imaging poses differential diagnosis with infectious TORCH chorioamnionitis. Fetal prognosis is ominous especially in the presence of oligohydramnios. We present four cases with a common ultrasound appearance, fetal growth restriction, Doppler abnormalities and pathological confirmation.

Marcadores séricos del primer trimestre y riesgo obstétrico en una población con alta prevalencia de obesidad / First-trimester serum markers and obstetric risk in a population with a high prevalence of obesity

Objetivo: La detección precoz del riesgo de complicaciones de la gestación como preeclampsia, parto pretérmino, y aborto, permitiría evitar morbimortalidad y secuelas. Hemos estudiado la relación entre niveles bajos de PAPP-A y BhCG con malos resultados obstétricos en una población con alta prevalencia de obesidad. Material y métodos: Estudio retrospectivo de casos y controles anidado en una cohorte de pacientes que acudieron para tamizaje de aneuploidías el I trimestre. Los casos fueron las pacientes con MoM PAPPA y/o BhCG por debajo del percentil 5 y el grupo control una muestra aleatorizada de pacientes con marcadores normales. Se ajustó por obesidad, edad, paridad, tabaquismo, y técnicas de reproducción. Resultados: La cohorte estuvo formada por 9111 pacientes. Se obtuvieron 382 casos con MoM PAPP-A inferior al percentil 5 y 325 con MoM BhCG por debajo del percentil 5, y 50 casos con ambos marcadores por debajo del percentil 5. Se tomaron 1417 controles. La prevalencia de obesidad fue del 20,7% y de sobrepeso el 28,4%. Los niveles bajos de PAPP-A se relacionaron con abortos, preeclampsia, crecimiento intrauterino retardado, pequeños para la edad gestacional, parto pretérmino y diabetes gestacional. Los niveles de BhCG por debajo del percentil 5 se relacionaron con la enfermedad hipertensiva gestacional. Los niveles de ambos marcadores por debajo del percentil 5 tuvieron relación significativa con aborto, preeclampsia precoz y parto pretérmino. Conclusión: Los niveles bajos de PAPP-A y BhCG se relacionan con malos resultados obstétricos en una población de alta prevalencia de obesidad.

Background: Early identification of pregnant women at risk of developing intrauterine growth restriction, preeclampsia, preterm birth, stillbirth, among other complications would allow more intensive surveillance to reduce the risk of severe disease. We aimed to study whether low levels of maternal serum markers PAPP-A and BHCG are associated with adverse pregnancy outcomes in an obese population. Methods: Cases were obtained from a cohort of 9111 patients who attended first trimester screening. We included women with PAPP-A and/or BHCG below the 5th percentile. A randomized group of women with serum markers above the 5th percentile was used as control group. Results were adjusted for age, parity, smoking status, BMI or reproductive techniques. Results: Prevalence of obesity was 20,7%. We found 382 women with PAPP-A below the 5th percentile, 325 with BHCG below the 5th percentile, 50 with both markers low, and recruited 1417 controls. The cases with low PAPP-A were significantly more likely to experience abortion, preeclampsia, low birth weight, preterm birth, or gestational diabetes. Low BHCG was significantly associated with gestational hypertension. Low BHCG and PAPP-A in the same patient correlated with abortion, early preeclampsia and preterm birth. Conclusions: Low levels of maternal serum markers correlate with adverse pregnancy outcomes in an obese population. We recommend to develop further calculators of obstetric risk to improve positive predictive value and to establish a maternal-fetal surveillance plan.

Evaluation and management of chemotherapy-induced cardiotoxicity in breast cancer: a Delphi study.

PURPOSE: While much progress has been made in the treatment of breast cancer, cardiac complications resulting from therapy remain a significant concern. Both anthracyclines and novel targeted agents can inflict cardiac damage. The present study aimed to evaluate the difference between what it is currently done and what standards of care should be used to minimizing and managing cardiac toxicity in breast cancer survivors. METHODS: A two-round multicenter Delphi study was carried out. The panel consisted of 100 oncologists who were asked to define the elected therapies for breast cancer patients, the clinical definition and patterns of cancer drug-derived cardiac toxicity, and those protocols focused on early detection and monitoring of cardiovascular outcomes. RESULTS: Experts agreed a more recent definition of cardiotoxicity. Around 38 % of patients with early-stage disease, and 51.3 % cases with advanced metastatic breast cancer had preexisting risk factors for cardiotoxicity. Among risk factors, cumulative dose of anthracycline ≥450 mg/m2 and its combination with other anticancer drugs, and a preexisting cardiovascular disease were considered the best predictors of cardiotoxicity. Echocardiography and radionuclide ventriculography have been the proposed methods for monitoring changes in cardiac structure and function. Breast cancer is generally treated with anthracyclines (80 %), so that the panel strongly stated about the need to plan a strategy to managing cardiotoxicity. A decline of left ventricular ejection fraction (LVEF) >10 %, to an LVEF value <53 % was suggested as a criterion for changing the dose schedule of anthracyclines, or suspending the treatment of chemotherapy plus trastuzumab until the normalization of the left ventricular function. The use of liposomal anthracyclines was strongly suggested as a treatment option for breast cancer patients. CONCLUSIONS: The present report is the first to produce a set of statements on the prevention, evaluation and monitoring of chemotherapy-induced cardiac toxicity in breast cancer patients.

Consensus and controversies in the definition, assessment, treatment and monitoring of BTcP: results of a Delphi study.

INTRODUCTION: There is no unanimous consensus on the clinical features to define breakthrough cancer pain (BTcP). The current project aimed to investigate the opinion of a panel of experts on cancer pain on how to define, diagnose, assess, treat and monitor BTcP. MATERIALS AND METHODS: A two-round Spanish multi-centre exploratory Delphi study was conducted with medical experts (n = 90) previously selected from Medical Oncology Services, Radiation Oncology, Palliative Care/Home Care Teams, and Pain Units. The study intended to seek experts' consensus and to define a set of recommendations for the management of BTcP. RESULTS: It was generally agreed that, definition of BTcP implies that baseline pain should be controlled (84 %), although not necessarily with opioids (only 30 %); there must be exacerbations (98.9 %); the duration of each episode should last <1 h (70 %); the intensity of pain ≥7 out of 10 (67.8 %); and the number of flares per day should not be less than four. All participants supported the use of the Davies algorithm for the diagnosis. The use of a 'Patient Diary' was highly recommended. The optimal treatment should have a rapid onset, a short-acting analgesic effect (1-2 h) and transmucosal nasal or oral administration. It was considered very important to develop protocols for the management of cancer pain. CONCLUSIONS: The present Delphi study identified a set of recommendations to define, assess and monitor BTcP.

Resultados perinatales en fetos con flujo umbilical diastólico ausente / Perinatal outcome in fetuses with absent end diastolic umbilical flow

Objetivo: Estudiar los resultados perinatales de fetos diagnosticados con flujo umbilical ausente en diástole en el Hospital Universitario de Canarias, España. Métodos: Estudio retrospectivo de gestantes con Doppler fetal umbilical con flujo diastólico ausente entre 2004 y 2011, excluyendo embarazos gemelares. Las variables estudiadas fueron: edad y enfermedades maternas, edad gestacional al diagnóstico y parto, vía de parto, Apgar y estado del recién nacido. Resultados: Se recogieron 57 casos. Hubo un 43 por ciento de gestantes hipertensas y 19 por ciento de diabéticas. La edad gestacional media al diagnóstico fue de 30+4 semanas. En el 89% de los casos se observó redistribución del flujo y en el 21 por ciento el Doppler umbilical fue reverso. El 28 por ciento se acompañó de oligoamnios y en el 26 por ciento el peso fetal estimado inferior al percentil 3. Hubo 3 muertes fetales. En el 80 por ciento de los casos la vía de parto fue por cesárea. La supervivencia fue del 83 por ciento con una tasa de mortalidad perinatal del 17 por ciento. En el seguimiento entre 1 y 6 años encontramos un 35 por ciento de niños sin secuelas. Conclusiones: En nuestra serie, el Doppler con flujo umbilical ausente en diástole se relaciona con alto riesgo de morbimortalidad perinatal. El 65 por ciento de los niños tendrán secuelas de algún tipo en el seguimiento entre 1 a 6 años. El momento óptimo para la extracción fetal debe ser individualizado y resuelto junto con el consejo pediátrico y participación de los padres.

Objective: To determine the perinatal outcome in fetal growth restriction were umbilical artery Doppler end diastolic flow was absent. Methods: A retrospective study performed at the Canary Islands University Hospital. All consecutive cases between 2004 and 2011 were included. We excluded twin pregnancies. Data was abstracted for maternal age, gestational age at diagnosis and delivery, mode of delivery, Apgar and perinatal adverse outcomes. Results: Fifty seven patients were included. Forty three percent had a pregnancy complicated by hypertension and 19 percent diabetes. Mean gestational age at diagnosis was 30+4 weeks. We found 89 percent and 21 percent absent umbilical artery end diastolic flow and reverse flow respectively. Oligohydramnios was seen in 28 percent of the cases. Fetal weight was below the third percentile in 26 percent of the cases. Fetal demise occurred in 3 cases. Mode of delivery was cesarean section in 80 percent of the cases. We found a rate of 17 percent perinatal mortality. At 1 to 6 years follow up 35 percent of the children had no sequelae. Conclusion: Absent end diastolic umbilical flow is associated with a high risk of perinatal mortality. Up to 65 percent of the children will show some type of sequelae. The optimal gestational date for fetal extraction should be individualized after multidisciplinary counseling.

Detección ecográfica y pronóstico de la ventriculomegalia fetal / Ultrasound detection and prognosis of fetal ventriculomegaly

Antecedentes: La ventriculomegalia fetal es un signo ecográfico muy sensible para las alteraciones del sistema nervioso central fetal. La morbilidad asociada a la misma depende principalmente de la etiología y de la presencia de otras malformaciones asociadas. Si es aislada y no progresiva se puede preveer un resultado posnatal favorable hasta en el 70 por ciento de los casos aunque hay una gran disparidad de cifras entre distintos centros y autores. Objetivo: Establecer la relación entre ventriculomegalia y pronóstico perinatal. Método: Se han revisado 60 casos diagnosticados mediante ecografía prenatal en el Hospital Universitario de Canarias siguiendo los criterios ecográficos de ventriculomegalia (astas posteriores mayores de 10 mm). Se realizaron cariotipos y serología materna y en líquido amniótico para completar el estudio. Resultados: Hubo un total de 23 interrupciones voluntarias de la gestación y 28 recién nacidos sin secuelas (47 por ciento). Un 70 por ciento de las ventriculomegalias aisladas correspondieron a recién nacidos sin secuelas. El 10 por ciento de las ventriculomegalias aparecieron en fetos con aneuploidías. Conclusión: El pronóstico fue favorable en los casos de ventriculomegalia no progresiva y aislada. La medida de la ventriculomegalia no predice el resultado. La variabilidad de resultados en la literatura obliga a cada centro a disponer de sus protocolos y datos para aconsejar a la pareja que ha de tomar una decisión sobre el futuro de su embarazo.

Background: Fetal ventriculomegaly is the most sensitive sonographic sign for central nervous system anomalies. Neonatal morbidity and mortality depends on the etiology of the ventriculomegaly and the presence of other malformations. Isolated non-progressive ventriculomegaly is associated with 70 percent favorable results, with a great disparity among studies. Aims: To establish the relationships between ventriculomegaly and perinatal outcome. Methods: The authors reviewed 60 cases of prenatally diagnosed fetal ventriculomegaly in the Canary Islands University Hospital. An ultrasonographic measurement of the lateral ventricles of 10 mm or more was considered as ventriculomegaly. Fetal and maternal serology was performed as well as fetal karyotyping. Results: 23 patients decided to terminate the pregnancy due to unfavorable prognosis. In 28 cases outcome was favorable. 70 percent of isolated ventriculomegaly corresponded to healthy newborns. 10 percent of the fetuses had aneuploidies. Conclusion: Prognosis is favorable if ventriculomegaly is isolated and non-progressive. Measurement of the lateral ventricle does not predict outcome. Disparity of results in literature makes it necessary for each Hospital to rely on their own data and guidelines to assess parents on the fate of the pregnancy.

Hidrops fetal como manifestación ecográfica de una enfermedad familiar: incontinentia pigmenti (síndrome de bloch-sulzberger) / Hydrops fetalis as a echographic manifestations of a familial disease: incontinentia pigmenti (bloch-sulzberger syndrome)

Diagnóstico de un caso de enfermedad familiar a partir de un hidrops fetal. Gestante con 2 abortos previos ocurridos al inicio del segundo trimestre, ambos fetos masculinos. Se detecta en la semana 12 un higroma quístico en el contexto de un hidrops fetal. Estudio serológico (TORCH y parvovirus B12), con resultado negativo y biopsia corial con cariotipo 46 XY. La anamnesis y exploración detallada hacen sospechar una enfermedad ligada al cromosoma X, dado que la paciente y una hermana están afectas de una genodermatosis desde la infancia: Incontinentia Pigmenti.

We revealed a family disease by a fetal anomaly. The patient had a history of two early miscarriages of male fetuses. In the present pregnancy hydrops fetalis was demonstrated by routine ultrasound sean at 12 weeks. Serological tests were negative and chorionic villous sampling revealed normal karyotype, 46XY. We suspected a X-linked disease. Detailed family history leaded to the demonstration that the patient and a sister were affected of a rare genodermatosis: Incontinentia Pigmenti.

Banda gástrica y gestación / Gastric band and pregnancy

Se presenta un caso de gestación en paciente obesa mórbida portadora de banda gástrica laparoscópica ajustable, que se descomprimió en el primer trimestre. En la evolución de la gestación destaca incremento ponderal de 3 kg y cuadro de suboclusion y marasmo en el tercer trimestre que obligó a la interrupción de la gestación mediante cesárea, produciéndose broncoaspiración y choque séptico secundario. Se revisa las series publicadas de embarazadas portadoras de banda gástrica y las complicaciones descritas en la gestación.

A case report is presented of a patient who became pregnant a year after morbid obesity surgery, the main complications of laparoscopy adjustable gastric band during pregnancy are discussed. In this case, the gastric band was adjusted to prevent first trimester vomiting. We observed the following complications: weight gain during pregnancy was limited to three kilograms and ileus and marasmus developed in the third trimester making pregnancy termination mandatory. During cesarean section the patient suffered aspiration pneumonia and secondary septic shock.

Teratoma quístico de ovario con concreciones solidas

Se presenta un caso de teratoma quístico maduro de ovario que contiene numerosas esférulas flotantes en el quiste. Se trataba de quiste de ovario gigante en una paciente en edad fértil. Las imágenes ecográficas y de la resonancia magnética destacan por su extraordinaria rareza y se piensa que son patognomónicas de teratoma quístico. El análisis anatomopatológico confirmó este resultado

We present a case of mature cystic teratoma of the ovary containing numerous spherules floating in the cyst. Sonography and MR imaging revealed spherical structures, which is thought to be pathognomonic for a cystic teratoma. Microscopically, the pathological report confirmed this finding. The cyst appears as a massive tumor in a reproductive age patient

Effect of interleukin-1 gene polymorphism in a periodontally healthy Hispanic population treated with mucogingival surgery.

OBJECTIVES: A genetic test for susceptibility of periodontal disease has been introduced. A positive test indicates a risk factor for more severe periodontal destruction. The prevalence of genotype positive subjects has been reported around 30%. In a Mexican population, we have found a 26% prevalence of genotype positive individuals. Few studies have reported the response to therapy in these individuals. The purpose of this study was to assess the response to mucogingival surgery in an otherwise periodontally healthy Hispanic population. MATERIALS AND METHODS: 22 subjects (7 male and 15 female) with a mean age of 45 years participated. They were treated 3 years prior for the treatment of Types I and II recession defects using connective tissue grafts. No other active periodontal treatment was required, except for preventive maintenance. A full-mouth clinical evaluation was performed which included assessment of gingival inflammation and measurements of probing pocket depth and clinical attachment levels. Mean values per patient were determined. A finger stick blood sample was collected using specially provided DNA filter paper, let dried, and mailed for processing. RESULTS: Results indicated that 5 out of the 22 subjects were genotype positive. The genotype positive subjects presented the following values: GI 1.13+/-0.17, PPD 2.48+/-0.46, and CAL 3.38+/-0.66. The values for the genotype negative subjects were GI 1.06+/-0.14, PPD 2.38+/-0.31 and CAL 3.11+/-0.53. No statistical significant differences were found when both groups were compared (p>0.05). Furthermore, the treatment of the localized recessions was effective and provided similar amount of coverage in genotype positive and negative subjects. However, more genotype negative subjects showed complete coverage of the recession than genotype positive individuals. CONCLUSIONS: Within the limits of this study it is concluded that (1) periodontal health can be maintained with proper preventive maintenance irrespective of the genotype present, (2) the mean response to mucogingival surgery to cover localized gingival recessions is similar irrespective of the IL-1 periodontal genotype, however, full coverage is achieved more frequently in genotype negative subjects.

[Epidemiological surveillance of patients treated with digoxin]. / Aportes en la vigilancia epidemiológica de los pacientes tratados con digoxina.

In the present study we assess that the etiology of digitalis intoxication. We try to identify factors and intensity of each association. One thousand fifty patients form Havana City, Cuba were selected, under digitalis therapy. Two groups were made Cases and Controls. Each patient was evaluated by direct interview. There was a significative association (P < 0.01) among digitalis intoxication and; older persons who use high doses of digoxin, other risk factors were underweight, lack of potassium supplement, some associated diseases, combination therapy between digoxin, and furosemide, thyazides, dipyridamole, amiodarone, quinidine, nifedipine or verapamil, cigar smoking, alcohol intake and prior history of digitalis intoxication. The odds ratio (OR) was calculated for each association. We conclude: some factors are responsible for digitalis intoxication, each one contribute partially.

Infeccion en el nino con inmunodeficiencia. Lineamientos sobre su prevencion y asistencia. / Infection in children with immunodeficiency. Features on its prevention and treatment

La infeccion es la principal causa de muerte en el huesped inmunodeficiente. Con el creciente uso de agentes antineoplasicos e inmunosupresores, el numero de este tipo de enfermos que se atiende en los hospitales es cada vez mayor, lo que ha hecho necesario establecer lineamientos de estudio, prevencion y tratamiento de la infeccion en el paciente pediatrico inmunodeficiente. Se hacen comentarios respecto a la epidemiologia de la infeccion y la fisiopatogenia de la inmunosupresion en relacion con la enfermedad o el tratamiento de fondo. Se sugiere un protocolo de estudio en el enfermo granulocitopenico febril, y se establecen conclusiones en cuanto a la prevencion y el tratamiento de las complicaciones infecciosas

Septicemias nosocomiales. Consideraciones generales y presentacion de 20 casos. / Nosocomial septicemias. General considerations and report of 20 cases

En este trabajo se hace hincapie en la importancia de las infecciones intrahospitalarias y se hacen consideraciones sobre los factores que influyen en las genesis de las septicemias. Se analizan 20 casos de septicemia de adquisicion intrahospitalaria tratando de correlacionar diferentes factores intrinsecos y extrinsecos del huesped con la causa de la septicemia se inicio despues de las 72 horas de estancia hospitalaria. Predominaron los germenes gramnegativos, en especial Klebsiella y Pseudomonas. La causa mas comun de ingresso fue la gastroenteritis y la existencia de desnutricion proteinocalorica avanzada.Predomino en los primeros meses de la vida. Todos estuvieron sometidos a diversas maniobras medicoquirurgicas, entre ellas laparotomias, venodisecciones, dialisis peritoneal y drogas inmunodepresoras. La letalidad en este estudio fue de 75%. Se encontro que la frecuencia de septicemias nosocomiales en el Hospital de Pediatria del Centro Medico Nacional del IMSS varia entre el 12.7% y el 14.0% de las infecciones intrahospitalarias

Etiologia de las gastroenteritis infecciosas de adquisicion intrahospitalaria. / Etiology of infectious gastroenteritis acquired in hospitals

Entre 77 ninos con diarrea de adquisicion intrahospitalaria, se demostro la presencia de microorganismos potencialmente patogenos en 45 (57 por ciento) y en solo 11 de 32 (34 por ciento) casos de control, con una diferencia significativa. Se encontraron rotavirus, Salmonela. E. coli seroagrupable, Shigella, E.histolytica y G. lamblia. Hubo una diferencia significativa entre ambos grupos en relacion con rotavirus. Salmonella y Shigella solo se encontraron en el grupo de pacientes. La presencia de E. coli seroagrupable fue casi igual en los dos grupos de ninos. El numero de parasitos encontrados fue muy pequeno y solamente se observaron quistes