Tratamiento quirúrgico del síndrome de apnea obstructiva del sueño infantil: comparación entre adenoamigdalectomía extracapsular con bisturí frío y reducción mediante radiofrecuencia bipolar / Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation

Introducción y objetivos: La cirugía adenoamigdalar para el tratamiento de los niños con apnea obstructiva del sueño es efectiva. La incomodidad y posibles complicaciones del postoperatorio han promovido la utilización de técnicas parciales que buscan mejorar estos aspectos sin renunciar a resolver el síndrome con la misma efectividad. El objetivo es presentar la experiencia de 2 grupos consecutivos de pacientes, uno tratado con cirugía amigdalar total extracapsular y otro con reducción con radiofrecuencia bipolar mediante tunelización. Metodo: Se comparan 96 niños tratados mediante adenoamigdalectomía total extracapsular con bisturí frío y 101 tratados mediante radiofrecuencia. Se evalúa el porcentaje de casos con persistencia del síndrome (índice de apnea-hipoapnea ≥3) y la mejoría de los síntomas clínicos a un año. Se compara también el porcentaje de complicaciones quirúrgicas y anestésicas en ambos grupos. Resultado: La persistencia del síndrome fue comparable estadísticamente en ambos grupos: 25% en el grupo de bisturí frío y 22,77% en el grupo de radiofrecuencia. Las complicaciones anestésicas (5% en el grupo de bisturí frío y 4,2% en el grupo de radiofrecuencia) y los porcentajes de hemorragia postoperatoria fueron muy bajos y estadísticamente comparables con ambas técnicas. Conclusión: En el tratamiento del síndrome de apnea obstructiva del sueño infantil, tanto la cirugía extracapsular con bisturí frío como la radiofrecuencia bipolar mediante tunelización son técnicas seguras y los resultados en la resolución del síndrome no muestran diferencias estadísticamente significativas (AU)

Introduction and objective: Adenotonsillectomy for treatment of childhood obstructive sleep apnoea is effective. The uncomfortable postoperative period and possible complications have significantly increased the use of partial techniques, seeking to improve these aspects while achieving the same results in resolving sleep apnoea. The aim was to present the experience with 2 consecutive groups of patients, comparing total tonsillectomy to bipolar radiofrequency ablation (RFA). Method: A group of 96 children that underwent total tonsilloadenoidectomy using cold dissection were compared to another group of 101 children that underwent RFA. In all cases, polysomnography was performed before and 1 year after surgery. The percentage of cases with persistent disease (apnea-hypopnea index ≥ 3) and the improvement of clinical symptoms at one year were evaluated. The percentages of surgical and anaesthetic complications in both groups were also compared. Result: The persistence of the syndrome was comparable in both groups: 25% in the cold dissection and 22.77% in the radiofrequency ablation group. Anaesthetic complications (5% in the group where cold dissection was used and 4.2% in the radiofrequency ablation group) and postoperative bleeding rates were very low and statistically comparable with both techniques. Conclusion: In the treatment of childhood obstructive sleep apnoea syndrome, both extracapsular surgery using cold scalpel and bipolar radiofrequency tunnelling techniques are safe. Likewise, results as to resolution of the syndrome show no statistically significant differences (AU)

Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation. / Tratamiento quirúrgico del síndrome de apnea obstructiva del sueño infantil: comparación entre adenoamigdalectomía extracapsular con bisturí frío y reducción mediante radiofrecuencia bipolar.

INTRODUCTION AND OBJECTIVE: Adenotonsillectomy for treatment of childhood obstructive sleep apnoea is effective. The uncomfortable postoperative period and possible complications have significantly increased the use of partial techniques, seeking to improve these aspects while achieving the same results in resolving sleep apnoea. The aim was to present the experience with 2 consecutive groups of patients, comparing total tonsillectomy to bipolar radiofrequency ablation (RFA). METHOD: A group of 96 children that underwent total tonsilloadenoidectomy using cold dissection were compared to another group of 101 children that underwent RFA. In all cases, polysomnography was performed before and 1 year after surgery. The percentage of cases with persistent disease (apnea-hypopnea index ≥ 3) and the improvement of clinical symptoms at one year were evaluated. The percentages of surgical and anaesthetic complications in both groups were also compared. RESULT: The persistence of the syndrome was comparable in both groups: 25% in the cold dissection and 22.77% in the radiofrequency ablation group. Anaesthetic complications (5% in the group where cold dissection was used and 4.2% in the radiofrequency ablation group) and postoperative bleeding rates were very low and statistically comparable with both techniques. CONCLUSION: In the treatment of childhood obstructive sleep apnoea syndrome, both extracapsular surgery using cold scalpel and bipolar radiofrequency tunnelling techniques are safe. Likewise, results as to resolution of the syndrome show no statistically significant differences.

Clinical characteristics of chronic kidney disease of nontraditional causes in Salvadoran farming communities.

INTRODUCTION: Chronic kidney disease is a serious health problem in El Salvador. Since the 1990s, there has been an increase in cases unassociated with traditional risk factors. It is the second leading cause of death in men aged >18 years. In 2009, it was the first cause of in-hospital death for men and the fifth for women. The disease has not been thoroughly studied. OBJECTIVE: Characterize clinical manifestations (including extrarenal) and pathophysiology of chronic kidney disease of nontraditional causes in Salvadoran farming communities. METHODS: A descriptive clinical study was carried out in 46 participants (36 men, 10 women), identified through chronic kidney disease population screening of 5018 persons. Inclusion criteria were age 18-59 years; chronic kidney disease at stages 2, 3a and 3b, or at 3a and 3b with diabetes or hypertension and without proteinuria; normal fundoscopic exam; no structural abnormalities on renal ultrasound; and HIV-negative. Examinations included social determinants; psychological assessment; clinical exam of organs and systems; hematological and biochemical parameters in blood and urine; urine sediment analysis; markers of renal damage; glomerular and tubular function; and liver, pancreas and lung functions. Renal, prostate and gynecological ultrasound; and Doppler echocardiography and peripheral vascular and renal Doppler ultrasound were performed. RESULTS: Patient distribution by chronic kidney disease stages: 2 (32.6%), 3a (23.9%), 3b (43.5%). Poverty was the leading social determinant observed. Risk factor prevalence: agrochemical exposure (95.7%), agricultural work (78.3%), male sex (78.3%), profuse sweating during work (76.3%), malaria (43.5%), NSAID use (41.3%), hypertension (36.9%), diabetes (4.3%). General symptoms: arthralgia (54.3%), asthenia (52.2%), cramps (45.7%), fainting (30.4). Renal symptoms: nycturia (65.2%), dysuria (39.1%), foamy urine (63%). Markers of renal damage: macroalbuminuria (80.4%), ß2 microglobulin (78.2%), NGAL (26.1%). Renal function: hypermagnesuria (100%), hyperphosphaturia (50%), hypernatriuria (45.7%), hyperkaluria (23.9%), hypercalciuria (17.4%), electrolyte polyuria (43.5%), metabolic alkalosis (45.7%), hyponatremia (47.8%), hypocalcemia (39.1%), hypokalemia (30.4%), hypomagnesemia (19.6%). Imaging: Ultrasound showed fatty liver (93.5%) and vascular Doppler showed tibial artery damage (66.7%). Neurological symptoms: abnormal tendon reflexes (45.6%), Babinski sign and myoclonus (6.5%), sensorineural hearing loss (56.5%). CONCLUSIONS: This chronic kidney disease studied behaves clinically like chronic tubulointerstitial nephropathy, but with systemic manifestations not attributable to kidney disease. While male agricultural workers predominated, women and adolescents were also affected. Findings support a hypothesis of multifactorial etiology with a key role played by nephrotoxic environmental agents.

Valoración del grado de coagulación y del factor anti-Xa al introducir el dializador AN69ST® con heparina impregnada / Evaluation of coagulation and anti-Xa factor using a heparin-coated AN69ST® dialyser

Introducción: Los sistemas de hemodiálisis tienen capacidad trombogénica, por lo que se utiliza de forma rutinaria la anticoagulación. Su prescripción no se encuentra exenta de riesgos, a pesar de lo cual las recomendaciones respecto a la dosis pautada siguen basándose en criterios muy diversos. Métodos: Se realizó un estudio experimental aleatorizado y cruzado. Seis pacientes realizaron seis sesiones de hemodiafiltración posdilución con el dializador de polisulfona HF80® y anticoagulación habitual con nadroparina, y seis sesiones con el dializador AN69ST® de poliacrilonitrilo con una cubierta de heparina sin el uso de anticoagulación sistémica. Evaluamos cada hora el grado de coagulación del dializador y del circuito extracorpóreo mediante una escala visual y las variaciones en los parámetros de coagulación, entre los que se incluyó el factor anti-Xa. Nuestro objetivo primario fue valorar las variaciones en la actividad del factor anti-Xa en ausencia de diferencias en la tasa de coagulación masiva entre los dos grupos. Resultados: No se coaguló el dializador de forma completa o grado 4 en ninguna de las 36 sesiones realizadas con cada dializador. Se produjo una coagulación parcial del dializador inferior del 25% (grado 1-2) en 32 (88,9%) sesiones con AN69ST® y 35 (97,2%) con el dializador habitual, y superior del 25% (grado 3-4) en 4 (11,1%) sesiones con AN69ST® y en 1 (2,8%) sesión con el dializador con heparina. La coagulación del atrapaburbujas arterial no fue superior al 25% (grados 3 y 4) en ninguna de las sesiones estudiadas, y la cámara venosa en sólo 1 (2,8%) sesión con el dializador habitual y 3 (8,4%) con AN69ST® sin diferencias entre los dos dializadores. El (..) (AU)

Background: Haemodialysis systems are potentially thrombogenic, so anticoagulation is routinely used. Its prescription involves certain risks, despite which the recommendations regarding dosage are still based on very disparate criteria. Methods: We performed a randomised, crossed pilot study. Six patients underwent six sessions of post-dilution haemodiafiltration with a polysulfone HF80® dialyser and standard anticoagulation with nadroparin, and six sessions with heparincoated poliacrylonitrile AN69ST® membrane without the administration of systemic anticoagulation therapy. The coagulation level of the dialyser and extracorporeal circuit was evaluated every hour using a visual scale along with variation in clotting parameters such as anti-Xa factor. Our primary objective was to assess anti-Xa activity in the absence of differences in the rate of massive coagulation between the two groups. Results: No complete or grade 4 dialyser clotting occurred in any of the 36 sessions with either dialyser. Partial clotting of the dialyser occurred below 25% (grade 1-2) in 32 (88.9%) AN69ST® sessions and 35 (97.2%) sessions using the standard dialyser, and partial clotting surpassed 25% (grade 3-4) in 4 (11.1%) AN69ST® sessions and 1 (2.8%) dialysis session with heparin. Arterial chamber blood clotting did not surpass 25% (grade 3 and 4) in any of the studied sessions, and venous chamber coagulation occurred in only 1 (2.8%) session with the usual dialyser and in 3 (8.4%) sessions with the AN69ST®, with no significant differences between the two (..) (AU)

Evaluation of coagulation and anti-Xa factor when using a heparin-coated AN69ST® dialyser.

BACKGROUND: Hemodialysis systems are potentially thrombogenic, so it is routinely used anticoagulation. Its prescription is with risks though which the recommendations regarding the scheduled dose are still based on very different criteria. METHODS: We performed a randomized, crossover pilot study. Six patients underwent six sessions of post-dilution hemodiafiltration with polysulfone HF80® dialyzer and standard anticoagulation with nadroparin, and six sessions with heparin-coated poliacrylonitrile AN69ST® membrane without using systemic anticoagulation. Dialyser and the extracorporeal circuit clotting grade was evaluated through visual scale every hour and coagulation parameters like anti-Xa factor. Our endpoint was to assess anti-Xa activity without differences in the rate of massive clotting between the two groups. RESULTS: No complete or grade 4 dialyzer clotting occurred in any of 36 sessions with each dialyzer. A partial lower 25% (grade 1-2) dialyzer clotting was in 32 (89.7%) AN69ST® sessions and 35 (97.2%) with the usual dialyzer and upper 25% (grade 3-4) in 4 (11.1%) AN69ST® sessions and 1 (2.8%) dialysis session with heparin. Arterial chamber blood coagulation was not greater than 25% (grade 3 and 4) in any of the studied sessions and the venous chamber in only 1 (2.8%) session with the usual dialyzer and 3 (8.4%) with no differences AN69ST® between the two dialyzers. The activated partial thromboplastin time at two hours showed differences between techniques related to administration of low molecular weight heparin (33.3 ± 2.7s with polysulfone and 27.5 ± 2.3s in AN69ST®; P < 0.05) which remained significant at the end of the session (29.8 ± 2.1s with polysulfone and 27.2 ± 1.8s with AN69ST®; P < 0.05). Anti-Xa factor activity was maximal two hours after administration of nadroparin, with differences between the two dialyzers (0.46 ± 0.13 IU / ml in dialysis with polysulfone and 0.04 ± 0.04 IU / ml with AN69ST®p<0.005) and went down after 4 hours (0.17 ± 0.12 IU / ml in dialysis with polysulfone and 0.02 ± 0.03 IU / ml in AN69ST®; p<0.05). One patient in dialysis AN69ST®; had an adverse reaction characterized by generalized pruritus and was excluded from the study, by withdrawing the consent in the first session. CONCLUSION: We demonstrate the low thrombogenicity of the AN69ST®; dialyzer that allows post-dilution hemodiafiltration sessions without systemic anticoagulation, and without increasing the frequency of severe clotting events compared to HF80®; dialyzer with nadroparin and with less risk of bleeding by not modifying the anti-Xa factor activity.

Dos casos de schwannoma intraparotídeo del nervio facial / Two cases of intraparotid facial nerve schwannoma

La localización intraparotídea de schwannomas del nervio facial es poco frecuente y su diagnóstico preoperatorio es difícil. Estos hechos causan controversia sobre cual es la actitud que debe seguirse ante la sospecha intraoperatoria de un schwannoma del nervio facial intraparotídeo. Se presentan dos casos de schwannoma intraparotídeo del nervio facial diagnosticados en el transcurso de una cirugía de parótida. Se describe la conducta terapéutica y seguimiento realizado en ambos casos (AU)

Intraparotid facial nerve schwannomas are rare, their preoperative diagnosis is difficult, and there are controversies about how to proceed when they are suspected intraoperatively. We present two cases of intraparotid facial nerve schwannoma that were diagnosed during parotid surgery, and describe the procedure and follow-up performed (AU)

[Two cases of intraparotid facial nerve schwannoma]. / Dos casos de schwannoma intraparotídeo del nervio facial.

Intraparotid facial nerve schwannomas are rare, their preoperative diagnosis is difficult, and there are controversies about how to proceed when they are suspected intraoperatively. We present two cases of intraparotid facial nerve schwannoma that were diagnosed during parotid surgery, and describe the procedure and follow-up performed.