[Incidence of catheter-related infection incidence and risk factors in patients on total parenteral nutrition in a third level hospital]. / Incidencia de infección asociada a catéter venoso central y factores de riesgo relacionados en pacientes con nutrición parenteral total en un hospital de tercer nivel.

BACKGROUND: Central venous catheters are devices used for therapeutic, diagnostic, and monitoring purposes. Complications associated with central venous catheter use include those related to their insertion, rupture and displacement of the catheter, occlusion, thrombosis, and infection. Of these the latter is important due to the high morbidity and mortality it causes in the patients, and total parenteral nutrition increases the risk. The aim of this study is determine the incidence and risk factors associated with catheter-related infection in patients on parenteral nutrition. MATERIAL AND METHODS: A retrospective, observational, and cross-sectional study was conducted, by analysing patients on total parenteral nutrition who developed a catheter-related infection in a 6-month period. Multiple variables were studied, looking for significance. A statistically significant relationship was considered with a p<0.05. RESULTS: The study consisted of 85 patients, of whom 52% were women and 48% men. The median age was 54 years. The most frequent diagnosis was enterocutaneous fistula. Catheter associated infection was present in 19% of patients. The most frequent microorganisms found were Staphyloccocus sp. (44%) and Candida sp. (25%). Median time between central venous catheter insertion and infection was 78±64 days. There was a significance between days with a central venous catheters and infection development (p=0.014). Infection developed in 81% of patients on whom surgery was performed (p<0.05) CONCLUSION: It was found that patients with a longer use of a central venous catheter (p=0.014) and those who were operated on in conjunction with total parenteral nutrition (p<0.05) were more prone to develop a catheter-associated infection.

Eventración diafragmática en el adulto. Reporte de un caso / Diaphragmatic eventration in adults. Case report

Resumen Introducción: El diafragma es un órgano fibromuscular cuya función fisiológica es otorgar la fuerza mecánica para la ventilación. Otra de las funciones del diafragma es dividir la cavidad torácica de la cavidad abdominal2. El diafragma se ve afectado rara vez por enfermedades. Entre las patologías primarias se encuentra la eventración diafragmática. Reporte de caso: Paciente del sexo femenino de 21 años de edad sin antecedentes de importancia quien presenta caída de su propia altura y trauma contuso en tórax. Se realiza radiografía como parte del estudio y se observa elevación del hemidiafragma izquierdo. El estudio se complementa con tomografía axial computada y se diagnostica eventración diafragmática. Ante los hallazgos, se plantea el procedimiento quirúrgico como terapia definitiva; sin embargo, la paciente no lo acepta, por lo que se ha mantenido en seguimiento por la consulta externa. Discusión: La eventración diafragmática es causada por debilidad de la parte muscular diafragmática. Se cree que es causada por la ausencia congénita o funcional de la musculatura diafragmática. El cuadro clínico generalmente es asintomático; en caso de existir sintomatología, ésta se relaciona a problemas respiratorios. El diagnóstico se corrobora con estudios radiológicos, de los cuales los más utilizados son la radiografía de tórax y la tomografía axial computada. El tratamiento puede ser conservador o quirúrgico. El pronóstico dependerá del grado de hipoplasia pulmonar y la de coexistencia de alguna otra alteración. Conclusión: La eventración diafragmática es rara vez diagnosticada en pacientes adultos asintomáticos. El manejo dependerá de la decisión del cirujano y del paciente.

Abstract Background: The diaphragm is a fibromuscular organ whose primary function is related to ventilation. It also serves as a barrier between pleural and abdominal cavities. This organ is rarely affected by pathologic entities, but eventration is among the primary diseases of this structure. Case Report: We present the case of a 21 year old female with no relevant personal history. She arrived to the emergency room with thoracic blunt trauma. Chest radiography is indicated, showing elevation of the left hemidiaphragm. This study was complemented with a computed tomography making a presumptive diagnosis of diaphragmatic eventration. As part of the treatment, we proposed surgical therapy but the patient refused and now she is under surveillance in her clinic. Discussion: Diaphragmatic eventration is caused by the weakness of the muscular part of the organ. It is thought that is caused by functional or congenital absence of the diaphragmatic musculature. The clinical presentation is variable but, in most of the cases, the patients are asymptomatic. The diagnosis is made by radiologic studies such as chest plains and computed tomography. Treatment could be conservative or surgical. The prognosis will depend on the degree of pulmonary hypoplasia and the coexistence of other malformations. Conclusion: Diaphragmatic eventration is rarely diagnosed in adults and the treatment will depend on the surgeon´s and the patient´s joined decision.

[Choledochal cyst during pregnancy. Report of 3 cases and a literature review]. / Quiste de colédoco y embarazo. Reporte de 3 casos y revisión de la bibliografía.

BACKGROUND: Choledochal cysts are rare. They usually present during childhood in women, but it can also be seen during pregnancy. Clinical signs and symptoms are obscured during this time, thus it can complicate the diagnosis and represent a life threatening complication for both the mother and the child. OBJECTIVE: To communicate the case of 3 pregnant patients with choledochal cyst. CLINICAL CASES: Three pregnant women in which choledochal cyst were diagnosed. Two developed signs of cholangitis. The first one underwent a hepatic-jejunostomy, but had an abortion and died on postoperative day 10. The second one had a preterm caesarean operation due to foetal distress and underwent a hepatic-jejunostomy 4 weeks later; during her recovery she had a gastric perforation and died of septic complications. The third one did not develop cholangitis or jaundice. She had an uneventful pregnancy and had a hepatic-jejunostomy 4 weeks later with good results. CONCLUSIONS: Management of choledochal cysts during pregnancy is related to the presence of cholangitis. When they do not respond to medical treatment, decompression of the biliary tree is indicated. Definitive treatment should be performed after resolution of the pregnancy.