Electrocardiograma y evaluación predeportiva en el niño que practica deporte / Electrocardiogram and pre-sports evaluation in the child who practices sports

Introducción: existe consenso en la necesidad de realizar un cribado predeportivo, aunque con enormes diferencias en cuanto a protocolos. El objetivo de nuestro estudio es conocer el estado de los reconocimientos predeportivos en niños, conocer la prevalencia de anomalías cardiovasculares y valorar la utilidad del electrocardiograma (ECG). Pacientes y métodos: estudio descriptivo transversal. Durante dos años se realizó el reconocimiento médico propuesto por la Guía Clínica de Evaluación Cardiovascular previa a la práctica deportiva en Pediatría en las revisiones de niños mayores de seis años, incluyendo anamnesis, exploración física y electrocardiograma. Resultados: se incluyeron 691 niños. El 62,5% realizaba deporte extraescolar con una mediana de 3 horas por semana (2-4,5). El 52,2% de los niños estaban federados. Existen diferencias en las horas de práctica deportiva y la edad entre niños federados y no federados (p <0,001). En los federados se realizó reconocimiento en el 68,1% y un ECG en el 19%, existiendo diferencias significativas entre los distintos tipos de deportes (p <0,001). El 13% de los niños estudiados presentaban antecedentes familiares de cardiopatía. El 3,5% de los ECG realizados fueron patológicos precisando valoración por Cardiología Pediátrica. El 6,6% de los niños con antecedentes familiares de cardiopatía y el 3% de los niños sin antecedentes necesitaron seguimiento cardiológico. Conclusiones: en la mayoría de los reconocimientos deportivos de nuestro medio no se incluye ECG. Investigar en profundidad los antecedentes familiares de cardiopatía es importante (AU)

Introduction: there is consensus on the need to perform pre-sport screening, although with enormous differences in terms of protocols. The objective of our study is to know the status of pre-sport screenings in children, to know the prevalence of cardiovascular abnormalities and to assess the usefulness of the electrocardiogram (ECG).Patients and methods: descriptive cross-sectional study. For two years, the medical screening proposed by the Clinical Guide for Cardiovascular Evaluation prior to sports practice in pediatrics was carried out in the check-ups of children older than 6 years, including anamnesis, physical examination and electrocardiogram.Results: 691 children were included. 62.5% did extracurricular sports with a median of 3 hours per week (2-4.5). 52.2% of the children were federated. There are differences in the hours of sports practice and age between federated and non-federated children (p <0.001). In federated, recognition was performed in 68.1% and ECG in 19%, with significant differences between the different types of sports (p <0.001). 13% of the children studied had a family history of heart disease. 3.5% of the ECGs performed were pathological, requiring evaluation by pediatric cardiology. 6.6% of the children with a family history of heart disease and 3% of the children without a history required cardiac follow-up.Conclusions: ECG is not included in most of the sports examinations in our environment. Investigating family history of heart disease is important. (AU)

Reparación de lesiones en nervios mediante el implante de prótesis obtenidas de segmentos acelulares de nervio isogénico / Repair of nerve injury by implanting prostheses obtained from isogenic acellular nerve segments

Introducción. Cuando se produce una sección nerviosa con separación significativa de los cabos es necesario utilizar una prótesis, a modo de puente, para suturarlos. La mejor prótesis es un segmento de nervio autógeno, pero presenta importantes inconvenientes. Nuestro objetivo es comparar la eficacia de la sutura simple con la tubulización para el implante de una prótesis de nervio isogénico descelularizado. Material y método. Se utilizan 4 grupos de ratas Wistar. Grupo 0: animales donantes de nervio ciático. Grupo 1: recibió el implante con sutura término-terminal. Grupo 2: recibió el implante dentro de un tubo de ??-caprolactona. Grupo 3: lo recibió en un tubo de poliláctico-co-glicólico. Se evaluó la función motora (índice ciático) y la extensión de la regeneración (estudio histológico) a las 3 semanas del implante. Resultados. La regeneración ha sido irregular en los 3 grupos experimentales. En todos hay implantes en los que las fibras nerviosas regeneran la longitud máxima estudiada (15mm) y otros en los que la regeneración es muy escasa. La longitud media de regeneración es mayor en el grupo de sutura directa (G1), aunque la velocidad es similar en los 3. El grupo 1 muestra el mayor porcentaje de regeneración, aunque la variabilidad de los resultados impide que esta diferencia alcance significación estadística. No hemos hallado diferencias significativas entre los dos grupos con tubos de diferentes polímeros. Conclusión. Para implantar prótesis de nervios isogénicos descelularizados es más eficaz, en nuestras condiciones experimentales, la sutura término-terminal que los tubos de polímeros biocompatibles (AU)

Introduction. When a nerve section with a significant gap occurs, it is necessary to use a prosthesis to suture it. To date an autologous nerve segment graft appears to be the best treatment; but it has several important disadvantages. Our goal is to study the effectiveness of an isogenic acellular nerve prosthesis comparing a simple suture with tubulisation. Material and method. Four groups of Wistar rats were used. The animals in Group 0 served as donors of nerve segments to graft. Group 1 received the implant with an end-to-end suture. In group 2, the implant was sutured inside an ??-caprolactone tube. Group 3 received it in a polylactic-co-glycolic acid tube. We evaluated the motor function (sciatic index and step test in motion), and the regeneration length by histological study of regeneration, after a maximum of 3 weeks. Results. Regeneration was uneven in the three groups. In all groups, there were implants with regenerated nerve fibres at the maximum studied length (15mm) and others where regeneration was scarce. The mean regeneration length was greater in the direct end-to-end suture group (G1), although the regeneration speed was similar in the three groups. Group 1 showed the highest percentage of regeneration, but the variability of results prevents this difference reaching statistical significance. We found no significant differences between the two groups with polymer tubes. Conclusion. For the implantation of isogenic acellular nerve prosthesis, under our experimental conditions, the direct end-to-end suture was more effective than when it isprotected with biopolymer tubes (AU)

Repair of nerve injury by implanting prostheses obtained from isogenic acellular nerve segments. / Reparación de lesiones en nervios mediante el implante de prótesis obtenidas de segmentos acelulares de nervio isogénico.

INTRODUCTION: When a nerve section with a significant gap occurs, it is necessary to use a prosthesis to suture it. To date an autologous nerve segment graft appears to be the best treatment; but it has several important disadvantages. Our goal is to study the effectiveness of an isogenic acellular nerve prosthesis comparing a simple suture with tubulisation. MATERIAL AND METHOD: Four groups of Wistar rats were used. The animals in Group 0 served as donors of nerve segments to graft. Group 1 received the implant with an end-to-end suture. In group 2, the implant was sutured inside an ɛ-caprolactone tube. Group 3 received it in a polylactic-co-glycolic acid tube. We evaluated the motor function (sciatic index and step test in motion), and the regeneration length by histological study of regeneration, after a maximum of 3 weeks. RESULTS: Regeneration was uneven in the three groups. In all groups, there were implants with regenerated nerve fibres at the maximum studied length (15mm) and others where regeneration was scarce. The mean regeneration length was greater in the direct end-to-end suture group (G1), although the regeneration speed was similar in the three groups. Group 1 showed the highest percentage of regeneration, but the variability of results prevents this difference reaching statistical significance. We found no significant differences between the two groups with polymer tubes. CONCLUSION: For the implantation of isogenic acellular nerve prosthesis, under our experimental conditions, the direct end-to-end suture was more effective than when it isprotected with biopolymer tubes.

Vascularization of the long process of the malleus: surgical implications.

Knowledge of the vascularization of the malleus may help to better understand some unwanted effects occurred in those surgical techniques using the handle as an attachment site of ossicle-replacement prostheses. Our hypothesis is that vascular damage occurred in the long process of the malleus during tympanic membrane detachment before fastening a malleovestibulopexy (MVP) prosthesis promotes the lysis of this ossicle at the attachment site. To confirm this premise, we carried out an evolutive and descriptive study of ten MVP procedures as well as a morphological analysis of ten cadaveric mallei using both light and scanning electron microscopies. The arterial supply of the manubrium comes from two main sources: vascular branches that reach this ossicle from the site of insertion of the tensor tympani tendon and small perforating branches which penetrate the bone from arteries of the tympanic membrane that, following the periosteum/perichondrium, they arrange parallel to the bone. The detachment of the tympanic membrane to fasten a MVP prosthesis causes a damage in the periosteal/perichondral vascular supply of the handle as well as micro-trauma on it, which can promote bone resorption at the point of anchorage by osteoclast stimulation. Respect periosteal vascularization of the manubrium may be important to prevent damage in this ossicle caused by some middle ear reconstruction prostheses.

[Regeneration of critical injuries of the peripheral nerve with growth factors]. / Regeneración de las lesiones críticas del nervio periférico con factores de crecimiento. Estudio experimental.

INTRODUCTION: This project aims to study the regeneration of non-repairable lesions of peripheral nerve by muscle grafts enhanced with growth factors. MATERIAL AND METHODS: The experiment was carried out in two phases. The first one compared direct suture of a critical defect in the sciatic nerve of ten rats, with the interposition of autologous muscle graft, denatured by heat, in another ten. The second phase compared ten rats with nerve repair using an acellular muscle graft, with injection of 2cc of IGF-1 (10mg/ml mecasermin, Injectable solution) into the acellular graft of another ten. A clinical and functional follow-up was carried out including, ambulation, footprint measurement, and "grasping test". . The animals were sacrificed at 90-100 days, and samples obtained for macro- and microscopic studies with toluidine blue, haematoxylin-eosin and Masson's trichrome staining. RESULTS: The first experiment showed the characteristic findings of nerve tissue in muscle graft level sections. The second was an enhancement of the results: post-surgical clinical improvement, early ambulation, decrease in the rate of pressure ulcers in toes, recovery of the footprint, and increasing the percentage of nerve endings in distal sciatic regeneration (47-62%). CONCLUSIONS: In this study the experimental and clinical possibilities of nerve defect repair by denatured muscle are demonstrated, confirming the suitability of the technique. Furthermore, it confirms our hypothesis with clinical and cellular determinations enriched by the addition of growth factors that promote nerve regeneration.

Regeneración de las lesiones críticas del nervio periférico con factores de crecimiento. Estudio experimental / Regeneration of critical injuries of the peripheral nerve with growth factors

Introducción. El objetivo del proyecto es estudiar la regeneración de las lesiones no reparables del nervio periférico, mediante un injerto muscular enriquecido con factores de crecimiento. Material y método. La experimentación se desarrolla en 2 fases: primero, comparamos la sutura directa del defecto crítico en el nervio ciático de 10 ratas, con la interposición de un injerto de músculo autólogo desnaturalizado por calor en otras 10. En la segunda, se comparan 10 ratas con reparación mediante injerto muscular acelular, con la inyección de 2 cc de IGF-1 (10 mg/ml de mecasermina, en solución inyectable) dentro del injerto acelular de otras 10. Realizamos el seguimiento clínico y el control funcional de la marcha, medición de la huella plantar y «Grasping Test». Fueron sacrificadas a los 90-100 días, obteniendo muestras para macro y microscopía, con tinciones de azul de toluidina, hematoxilina-eosina y tricrómico de Masson. Resultados. La primera experimentación demostró el hallazgo de tejido de características nerviosas en las secciones del injerto muscular. La segunda supuso una potenciación de los resultados: mejoría clínica posquirúrgica, precoz deambulación, descenso en la tasa de úlceras por presión en partes acras, recuperación de la huella plantar, e incremento del porcentaje de terminaciones nerviosas en regeneración del cabo distal (47-62%). Conclusiones. Exponemos en este trabajo las posibilidades experimentales y clínicas de la reparación del defecto nervioso mediante músculo desnaturalizado, confirmando la adecuación de la técnica. Además, confirmamos nuestra hipótesis con clínica y determinaciones celulares enriquecidas por la adicción de factores de crecimiento que impulsan la regeneración nerviosa (AU)

Introduction. This project aims to study the regeneration of non-repairable lesions of peripheral nerve by muscle grafts enhanced with growth factors. Material and methods. The experiment was carried out in two phases. The first one compared direct suture of a critical defect in the sciatic nerve of ten rats, with the interposition of autologous muscle graft, denatured by heat, in another ten. The second phase compared ten rats with nerve repair using an acellular muscle graft, with injection of 2 cc of IGF-1 (10 mg/ml mecasermin, Injectable solution) into the acellular graft of another ten. A clinical and functional follow-up was carried out including, ambulation, footprint measurement, and «Grasping Test». The animals were sacrificed at 90-100 days, and samples obtained for macro- and microscopic studies with toluidine blue, haematoxylin-eosin and Masson's trichrome staining. Results. The first experiment showed the characteristic findings of nerve tissue in muscle graft level sections. The second was an enhancement of the results: post-surgical clinical improvement, early ambulation, decrease in the rate of pressure ulcers in toes, recovery of the footprint, and increasing the percentage of nerve endings in distal sciatic regeneration (47-62%). Conclusions. In this study the experimental and clinical possibilities of nerve defect repair by denatured muscle are demonstrated, confirming the suitability of the technique. Furthermore, it confirms our hypothesis with clinical and cellular determinations enriched by the addition of growth factors that promote nerve regeneration (AU)

Alteraciones morfofuncionales en el bulbo olfatorio tras privación de estímulos olorosos (II). Estudio histoquímico / Morphofunctional disorders in olfactory bulb after privation of odoriferous stimuli (II). Histochemical study

Mediante técnicas histoquímicas e inmunohistoquímicas estudiamos los efectos que tiene la privación de estímulos olorosos en los primeros días tras el nacimiento sobre la actividad del bulbo olfatorio del jerbo (Meriones Unguiculatus). Esta privación sensorial de estímulos ocasiona reducciones drásticas en determinadas actividades enzimáticas (Tirosín Hidroxilasa) no alterando otras (DOPA-Decarboxilasa). Ello indica que la maduración funcional de determinados sistemas enzimáticos precisan de una integridad de sus aferencias sensoriales, mientras que no es necesaria para el normal funcionamiento de otros enzimas incluso dentro de la misma década (AU)

By histochemical and immunohistochemical methods we study the effects that has the odorous stimuli privation in the first day after the birth on the activity of the olfactory bulb of the gerbil (Meriones Unguiculatus). This sensory deprivation of stimuli causes drastic reductions in given activities (Tyrosine Hydroxylase) no altering other (DOPA-Decarboxylase). This indicates that the functional ripeness of given enzymatic systems specify of an integrity of their sensorial afferences, while it is not necessary for the normal activity of other enzymes even within the same cell (AU)

Alteraciones morfofuncionales en el bulbo olfatorio tras privación de estímulos olorosos (I). Estudio morfológico / Morphofunctional disorders in olfactory bulb after privation of odoriferous stimuli (I). Morphological study

Estudiamos la plasticidad del sistema nervioso analizando la repercusión macro y microscópica que sobre el bulbo olfatorio del jerbo (Meriones Unguiculatus) tiene la privación de estímulos olorosos en los primeros días tras el nacimiento. Esta privación sensorial de estímulos reduce el tamaño del bulbo en el lado tratado y altera los volúmenes de algunas de las capas bulbares. Ello indica que el desarrollo estructural del sistema nervioso precisa de una integridad de sus aferencias sensoriales (AU)

We study the olfactory bulb plasticity by olfactory deprivation in the jerbil (Meriones Unguiculatus). We analyze what effects has the odorous stimuli privation in the first days after the birth on the olfactory bulb. We have found that this stimuli absence reduces the size of the bulb in the discussed side and alters the volumes of some of the bulbars layers. This indicates that the structural development of the nervous system specifies of an integrity of their sensorial afferencies (AU)

[Morphofunctional changes in olfactory bulb after elimination of smell stimuli (I). Morphologic study]. / Alteraciones morfofuncionales en el bulbo olfatorio tras privación de estímulos olorosos (I). Estudio morfológico.

We study the olfactory bulb plasticity by olfactory deprivation in the jerbil (Meriones Unguiculatus). We analyze what effects has the odorous stimuli privation in the first days after the birth on the olfactory bulb. We have found that this stimuli absence reduces the size of the bulb in the discussed side and alters the volumes of some of the bulbars layers. This indicates that the structural development of the nervous system specifies of an integrity of their sensorial afferencies.

[Morphofunctional changes in the olfactory bulb after odor stimuli deprivation (II). Histochemical study]. / Alteraciones morfofuncionales en el bulbo olfatorio tras privación de estímulos olorosos (II). Estudio histoquímico.

By histochemical and immunohistochemical methods we study the effects that has the odorous stimuli privation in the first day after the birth on the activity of the olfactory bulb of the gerbil (Meriones Unguiculatus). This sensory deprivation of stimuli causes drastic reductions in given activities (Tyrosine Hydroxylase) no altering other (DOPA-Decarboxylase). This indicates that the functional ripeness of given enzymatic systems specify of an integrity of their sensorial afferences, while it is not necessary for the normal activity of other enzymes even within the same cell.