Extirpación laparoscópica de quiste paraovárico gigante en pediatría / Laparoscopic removal of giant paraovarian cyst in pediatrics

El quiste paraovárico se desarrolla en el ligamento ancho, entre la trompa de Falopio y el ovario. Son estructuras redondeadas de pared lisa, llenas de líquido seroso, que se ubican en el mesosálpinx, el ligamento ancho o sobre la propia trompa uterina. Tienen una incidencia aproximada de 1 en 1 500 0002 son frecuentes en la tercera y cuarta década de la vida; raramente se presentan en la edad pediátrica. Generalmente, son benignos y tiene un crecimiento lento y progresivo, suelen ser asintomáticos por lo que el diagnóstico suele ser incidental. En casos de quistes de gran volumen, los síntomas son dolor pélvico o la tumoración ab-dominal. Usualmente son diagnosticados clínicamente y se confirman por imágenes ultrasonográficas. La importancia de este caso es la poca frecuencia de estos tumores en la edad pediátrica y su identificación oportuna por parte de los profesionales de la salud

The paraovarian cyst develops in the broad ligament, between the fallopian tube and the ovary. They are rounded structures with a smooth wall, filled with serous fluid, which are located in the mesosalpinx, the broad ligament or on the uterine tube itself. They have an approximate incidence of 1 in 1,500,0002 and are common in the third and fourth decades of life; they rarely occur in childhood. Generally, they are benign and have a slow and progressive growth, they are usually asymptomatic, so the diagnosis is usually incidental. In cases of large volume cysts, the symptoms are pelvic pain or abdominal mass. They are usually diagnosed clinically and confirmed by ultrasonographic images. The importance of this case is the infrequency of these tumors in the pediatric age and their timely identification by health professionals

Aplicación de la normativa en el manejo de pie diabetico en el Hospital Nacional "Juan José Fernández", Zacamil. Octubre­noviembre 2018 / Application of regulations in the management of diabetic foot in the National Hospital "Juan José Fernández", Zacamil. October ­ November 2018

OBJETIVO. Valorar la aplicación de la "Norma de Pie Diabético Abordaje inicial, Procedimientos de Hospitalización y Enlace Multidisciplinario en el Hospital Nacional Zacamil (HNZ), por las diferentes especialidades médicas en los meses de octubre y noviembre de 2018. DISEÑO. Estudio descriptivo, transversal. Se revisó un total de 57 expedientes clínicos de los egresos hospitalarios en los meses indicados, en los que se evalúo la aplicación de la norma en la atención de emergencia, la hospitalización, la realización de procedimientos quirúrgicos y el momento del alta RESULTADOS. El servicio de emergencia en las 5 variables evaluadas tiene cumplimiento mayor al 80%. En Hospitalización se evidenció apego a la antibiótico terapia recomendada en el 100% de los casos. No se encontró evidencia de evaluación por equipo de especialistas y cirugía vascular periférica en más del 85% de los expedientes. La mayoría de los procedimientos quirúrgicos sean menores o mayores se realizaban después de 24 horas de haber sido programados. Al momento de su egreso se evidenció que más del 85% de pacientes fueron despachados en condiciones de euglicemia, sin signos de infección y con seguimiento en la consulta externa. Sin embargo, en menos del 35% de los expedientes se encontró evidencia de educación al cuidador, referencia a a Unidad Comunitaria de Salud Familiar (UCSF) y control en la Clínica de Úlceras y Heridas (CUH). CONCLUSIONES. El servicio de Emergencia es el que más apego presentó a la normativa descrita. Existen brechas importantes en la atención del paciente con PD en la hospitalización, principalmente en la realización de sus procedimientos quirúrgicos, evaluaciones por especialistas, en la educación al cuidador y la utilización de la CUH al momento del alta

Citotoxicidade da resina acrílica com e sem adesivo temático para confecção da placa de Hawley / Acrylic resin cytotoxicity with and without thematic adhesive for hawley retainer

As placas de Hawley podem ser utilizadas como aparelhos passivos de contenção pós-movimentação ortodôntica, confeccionadas com resina acrílica e grampos de aço. Como todo aparelho removível, seu efeito depende da colaboração do paciente na sua utilização, principalmente de pacientes jovens. A confecção da placa de Hawley com adesivos temáticos surgiu com o objetivo de diminuir esse problema, motivando o paciente quanto ao seu uso. Avaliou-se, in vitro, a biocompatibilidade da resina acrílica com e sem adesivo temático. A citotoxicidade das resinas com e sem adesivos foi avaliada por meio de estudo colorimétrico em células L929, incubadas por 1, 2, 3 e 8 dias, em contato direto com corpos de prova. A quantificação das células viáveis foi realizada por espectrofotometria. Foi verificada baixa viabilidade celular nos dois grupos avaliados, com menores valores de absorbância no grupo das resinas com adesivo temático. Conclui-se que as resinas acrílicas com e sem adesivos temáticos apresentaram elevado grau de citotoxicidade, sendo que as resinas acrílicas sem adesivo apresentaram aumento na viabilidade celular após 8 dias, fator não observado nas resinas temáticas.(AU)

Hawley retainers are commonly used as a passive orthodontic appliance, made with acrylic resin and stainless steel clasps. Like any removable appliance, its effect depends on patient collaboration in its use, especially in young patients. Hawley's retainers with thematic adhesives came to motivate patient and minimize this problem. This study aimed to evaluate in vitro biocompatibility of the acrylic resin with and without the thematic adhesive. The resins cytotoxicity with and without adhesives was evaluated by means of a colorimetric study in L929 cells, incubated for 1, 2, 3, and 8 days, in direct contact with the samples. The viable cell quantification was performed by spectrophotometry. Low cell viability was observed in the two groups evaluated, with lower absorbance values in the resin group with thematic adhesive. It was concluded that acrylic resins with and without thematic adhesives presented high cytotoxicity. Adhesive-free acrylic resins presented an increase in cell viability after 8 days, which was not observed in resins with thematic adhesives. (AU)

Longitudinal assessment of the lung mechanics of very low birth weight preterm infants with and without bronchopulmonary dysplasia.

CONTEXT AND OBJECTIVE: Prematurity has been correlated with altered lung mechanics. Some infants develop lung injury as a consequence of lung immaturity, invasive mechanical ventilation and exposure to oxygen, thus resulting in bronchopulmonary dysplasia. The aim here was to compare the lung mechanics of preterm infants with and without bronchopulmonary dysplasia during the first year of life. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: This study included premature infants at a public hospital who underwent two pulmonary function tests: one at discharge and the other at the corrected age of 4 to 8 months. Tidal volume, lung compliance and lung resistance were measured. Statistical tests were used for comparisons between infants with and without bronchopulmonary dysplasia. RESULTS: 102 children with mean gestational age of 29 ± 2.0 weeks were studied; 17 with bronchopulmonary dysplasia. Lung compliance (0.84 ± 0.29 versus 1.28 ± 0.46; P < 0.001) and tidal volume (6.1 ± 0.94 versus 7.2 ± 1.43; P < 0.01) at discharge were significant lower in children with bronchopulmonary dysplasia than in those without the disease, but no differences were observed at the second test (compliance: 1.53 ± 0.77 versus 1.94 ± 1.01; P = 0.12; and tidal volume: 6.9 ± 1.4 versus 7.3 ± 1.6; P = 0.42). CONCLUSION: Differences in lung mechanics were observed between infants with and without bronchopulmonary dysplasia at hospital discharge but these differences were no longer detected at the final follow-up. The lung mechanics of all the infants improved over this period of time.

Longitudinal assessment of the lung mechanics of very low birth weight preterm infants with and without bronchopulmonary dysplasia / Avaliação longitudinal da mecânica pulmonar de crianças pré-termo de muito baixo peso com e sem displasia broncopulmonar

ABSTRACT CONTEXT AND OBJECTIVE: Prematurity has been correlated with altered lung mechanics. Some infants develop lung injury as a consequence of lung immaturity, invasive mechanical ventilation and exposure to oxygen, thus resulting in bronchopulmonary dysplasia. The aim here was to compare the lung mechanics of preterm infants with and without bronchopulmonary dysplasia during the first year of life. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: This study included premature infants at a public hospital who underwent two pulmonary function tests: one at discharge and the other at the corrected age of 4 to 8 months. Tidal volume, lung compliance and lung resistance were measured. Statistical tests were used for comparisons between infants with and without bronchopulmonary dysplasia. RESULTS: 102 children with mean gestational age of 29 ± 2.0 weeks were studied; 17 with bronchopulmonary dysplasia. Lung compliance (0.84 ± 0.29 versus 1.28 ± 0.46; P < 0.001) and tidal volume (6.1 ± 0.94 versus 7.2 ± 1.43; P < 0.01) at discharge were significant lower in children with bronchopulmonary dysplasia than in those without the disease, but no differences were observed at the second test (compliance: 1.53 ± 0.77 versus 1.94 ± 1.01; P = 0.12; and tidal volume: 6.9 ± 1.4 versus 7.3 ± 1.6; P = 0.42). CONCLUSION: Differences in lung mechanics were observed between infants with and without bronchopulmonary dysplasia at hospital discharge but these differences were no longer detected at the final follow-up. The lung mechanics of all the infants improved over this period of time.

RESUMO CONTEXTO E OBJETIVO: Prematuridade tem sido associada com mecânica pulmonar alterada. Algumas crianças desenvolvem lesão pulmonar como consequência de imaturidade pulmonar, ventilação mecânica invasiva e exposição a oxigênio, resultando em displasia broncopulmonar. O objetivo foi comparar a mecânica pulmonar de prematuros com e sem displasia broncopulmonar durante o primeiro ano de vida. DESENHO DO ESTUDO E LOCAL: Estudo de coorte prospectivo em um hospital terciário. MÉTODOS: O estudo incluiu prematuros, de hospital público, que realizaram duas provas de função pulmonar, uma na alta e outra entre quatro e oito meses de idade corrigida. Foram mensurados o volume corrente, a complacência e a resistência pulmonares. Testes estatísticos foram usados para comparações entre crianças com e sem displasia broncopulmonar. RESULTADOS: Foram estudadas 102 crianças com idade gestacional média de 29 ± 2 semanas; 17 com displasia broncopulmonar. A complacência pulmonar (0,84 ± 0,29versus 1,28 ± 0,46; P < 0.001) e o volume corrente (6,1 ± 0,94 versus 7,2 ± 1,43; P < 0.01) na alta foram significativamente inferiores nas crianças com displasia broncopulmonar comparadas às crianças sem a doença, mas não foram observadas diferenças significativas no segundo teste (complacência: 1.53 ± 0.77versus 1.94 ± 1.01; P = 0.12; e volume corrente: 6.9 ± 1.4 versus 7.3 ± 1.6; P = 0.42). CONCLUSÃO: Diferenças na mecânica pulmonar foram observadas entre crianças com e sem displasia broncopulmonar na alta hospitalar, mas essas diferenças não foram detectadas no seguimento final. A mecânica pulmonar de todas as crianças melhorou no decorrer desse período de tempo.

Development of a technique for evaluating temporal parameters of sucking in breastfeeding preterm newborns.

AIMS: The aim of the current study was to developed and test the reliability of a technique for measuring temporal parameters of sucking in breastfeeding infants. METHODS: The technique was developed using a cohort of 11 term and 12 preterm infants, and subsequently evaluated using a cohort of 43 preterm infants. Measurements related to sucking pressure in the term and preterm infants were acquired. The signals were recorded for 5 min, saved on a computer, and stored for analysis. For purposes of analysis, the minute with the highest quality signal was chosen. Signal analysis was performed by two researchers, and inter- and intra-observer agreement was assessed. The newborns in the sample had different gestational ages. RESULTS: A technique was developed for the analysis of temporal parameters of sucking during breastfeeding and evaluated in 43 preterm infants with different gestational ages for the following variables: number of bursts per minute, number of sucks per burst, sucking rate, pause rate, and duration of pauses. The intra-observer agreement was 0.85 and the inter-observer agreement was 0.85. CONCLUSIONS: The technique that was developed and validated proved capable of measuring temporal parameters of sucking in breastfeeding newborns.

A randomized study of the efficacy of sensory-motor-oral stimulation and non-nutritive sucking in very low birthweight infant.

UNLABELLED: To assess if sensory-motor-oral stimulation and non-nutritive sucking gavage feeding enhances the oral feeding performance of preterm infants born between 26 and 32 weeks of gestational age. STUDY DESIGN: Very low birthweight infants (n=98) were randomized into a experimental and control group. Preterm infants in the experimental group received sensory-motor-oral stimulation and non-nutritive sucking and infants in the control group received a sham stimulation program. Both were administered from when they reached enteral diet (100 kcal/kg/day) until the beginning of oral diet. Primary outcome was length of hospital stay. RESULTS: Independent oral feeding was attained significantly earlier in the experimental group than the control group, 38+/-16 days of life (mean+/-S.D.) versus 47+/-17 days of life, respectively (P<0.001) There was significant difference in length of hospital stay between the two groups (41.9+/-17 (mean+/-S.D.) versus 52.3+/-19 days (P<0.01)). CONCLUSION: Sensory-motor-oral stimulation, together with early non-nutritive sucking (as soon as the newborn reaches full diet and is clinically stable) in very low birthweight preterm infants, as long as they are clinically stable, in this study, earlier initiation of oral feeding and earlier hospital discharge.

Neonatal risk factors for respiratory morbidity during the first year of life among premature infants.

CONTEXT AND OBJECTIVE: There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro. METHODS: Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression. RESULTS: Ninety-seven newborn infants (mean birth weight: 1113 g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater. CONCLUSIONS: Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.

Neonatal risk factors for respiratory morbidity during the first year of life among premature infants

CONTEXTO E OBJETIVO: Na última década ocorreu aumento dramático na sobrevida dos prematuros de muito baixo peso ao nascer. Contudo, a morbidade respiratória é ainda um problema. O objetivo deste estudo é verificar a associação entre mecânica pulmonar, avaliação estrutural pulmonar e a morbidade respiratória no primeiro ano de vida. TIPO DE ESTUDO E LOCAL: Coorte prospectivo realizado no Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. MÉTODOS: Participantes: prematuros com peso de nascimento inferior a 1.500 g. Antes da alta hospitalar foram realizadas prova de função pulmonar e tomografia computadorizada de tórax de alta resolução. As crianças foram acompanhadas durante o primeiro ano de vida e avaliadas quanto à presença de morbidade respiratória (síndrome obstrutiva de vias aéreas, pneumonia, internação). Resultados da prova de função pulmonar, tomografia de tórax e co-variáveis potencialmente associadas com morbidade respiratória foram avaliadas independentemente, usando-se risco relativo (RR). Os riscos relativos foram posteriomente ajustados através de regressão logística.RESULTADO: Estudamos 97 prematuros com peso de nascimento médio de 1.113 g e idade gestacional 28 semanas. A complacência pulmonar estava alterada em 40% dos casos e a resistência, em 59%. Alterações tomográficas ocorreram em crianças, morbidade respiratória em 53%. Na análise bivariada, as co-variáveis associadas com a morbidade respiratória foram: ventilação mecânica, uso prolongado de oxigênio (além de 28 dias), oxigênio às 36 semanas, doença de membrana hialina, pneumonia neonatal, persistência do canal arterial. Na análise multivariada o risco para alteração simultânea da complacência pulmonar e tomografia de tórax foi 2,7 (intervalo de confiança, IC: 0,7-10,0). No cálculo do risco ajustado as co-variáveis pneumonia neonatal e ventilação mecânica obtiveram uma magnitude maior. CONCLUSÃO: Encontramos altas taxas de alterações na mecânica pulmonar e na tomografia de tórax. Mais de 50% das crianças apresentaram morbidade respiratória no primeiro ano de vida. Os fatores de risco estatisticamente significativos foram pneumonia neonatal e assistência ventilatória.

Lung mechanics and high-resolution computed tomography of the chest in very low birth weight premature infants.

CONTEXT: Premature infant lung development may be affected by lung injuries during the first few weeks of life. Lung injuries have been associated with changes in lung mechanics. OBJECTIVE: To evaluate an association between lung mechanics and lung structural alterations in very low birth weight infants (birth weight less than 1500 g). DESIGN: A cross-sectional evaluation of pulmonary mechanics (lung compliance and lung resistance) and high resolution computed tomography of the chest at the time of discharge, in 86 very low birth weight infants born at Instituto Fernandes Figueira, a tertiary public healthcare institution in Rio de Janeiro, Brazil. Lung compliance and resistance were measured during quiet sleep. High resolution computed tomography was performed using Pro Speed-S equipment. MAIN MEASUREMENTS: Statistical analysis was performed by means of variance analysis (ANOVA/Kruskal Wallis). The significance level was set at 0.05. RESULTS: Abnormal values for both lung compliance and lung resistance were found in 34 babies (43%), whereas 20 (23.3%) had normal values for both lung compliance and lung resistance. The mean lung compliance and lung resistance for the group were respectively 1.30 ml/cm H2O/kg and 63.7 cm H2O/l/s. Lung alterations were found via high-resolution computed tomography in 62 (72%) infants. Most infants showed more than one abnormality, and these were described as ground glass opacity, parenchymal bands, atelectasis and bubble/cyst. The mean compliance values for infants with normal (1.49 ml/cm H2O/kg) high resolution computed tomography, 1 or 2 abnormalities (1.31 ml/cm H2O/kg) and 3 or more abnormalities (1.16 ml/cm H2O/kg) were significantly different (p=0.015). Our data were insufficient to find any association between lung resistance and the number of alterations via high-resolution computed tomography. CONCLUSION: The results show high prevalence of lung functional and tomographic abnormalities in asymptomatic very low birth weight infants at the time of discharge. They also show an association between lung morphological and functional abnormalities.

Lung mechanics and high-resolution computed tomography of the chest in very low birth weight premature infants

CONTEXT: Premature infant lung development may be affected by lung injuries during the first few weeks of life. Lung injuries have been associated with changes in lung mechanics. OBJECTIVE: To evaluate an association between lung mechanics and lung structural alterations in very low birth weight infants (birth weight less than 1500 g). DESIGN: A cross-sectional evaluation of pulmonary mechanics (lung compliance and lung resistance) and high resolution computed tomography of the chest at the time of discharge, in 86 very low birth weight infants born at Instituto Fernandes Figueira, a tertiary public healthcare institution in Rio de Janeiro, Brazil. Lung compliance and resistance were measured during quiet sleep. High resolution computed tomography was performed using Pro Speed-S equipment. MAIN MEASUREMENTS: Statistical analysis was performed by means of variance analysis (ANOVA/ Kruskal Wallis). The significance level was set at 0.05. RESULTS: Abnormal values for both lung compliance and lung resistance were found in 34 babies (43 percent), whereas 20 (23.3 percent) had normal values for both lung compliance and lung resistance. The mean lung compliance and lung resistance for the group were respectively 1.30 ml/cm H2O/kg and 63.7 cm H2O/l/s. Lung alterations were found via high-resolution computed tomography in 62 (72 percent) infants. Most infants showed more than one abnormality, and these were described as ground glass opacity, parenchymal bands, atelectasis and bubble/cyst. The mean compliance values for infants with normal (1.49 ml/cm H2O/kg) high resolution computed tomography, 1 or 2 abnormalities (1.31 ml/cm H2O/kg) and 3 or more abnormalities (1.16 ml/cm H2O/kg) were significantly different (p = 0.015). Our data were insufficient to find any association between lung resistance and the number of alterations via high-resolution computed tomography. CONCLUSION: The results show high prevalence of lung functional and tomographic abnormalities in asymptomatic very low birth weight infants at the time of discharge. They also show an association between lung morphological and functional abnormalities

Mecanica pulmonar no recem-nascido normal / Pulmonary mechanics in the full-term newborn

Este trabalho tem como objetivo avaliar a funcao pulmonar do recem-nascido a termo, comparando as tecnicas classicas de analise com a tecnica nao invasiva de analise de um ciclo respiratorio, descrevendo o laboratorio de fisiologia pulmonar desenvolvido no IFF e o software utilizado. Estudamos 10 RNs a termo com peso medio de 3,260g +- 460g, sem qualquer patologia. Os estudos foram realizados apos uma mamada. Foram realizadas oclusoes no final da inspoiracao e no inicio da expiracao para calcular os valores de mecanica pulmonar pela tecnica nao invasiva, determinando a Complacencia do Sistema Respiratorio (CSR) e a Resistencia do Sistema Respiratorio (RSR). Medimos a pressao esofagiana com um cateter n.6F preenchido com agua, ligado a um transdutor de pressao, colocado no 1/3 distal do esofago, possibilitando o calculo da Complascencia Pulmonar(CP) pela tecnica classica. Os dados foram digitados a 60HZ atraves de uma placa conversora, em um microcomputador AT 286, para analise posterior. A analise dos dados foi feita atraves de um software especialmente desenvolvido para processamento de sinais fisiologicos. Os resultados mostram valores para a CP de 1,78+-0,36 ml/cmH2O/kg, para a CSR de 1,12+-0,27 ml/cmH2O/kg e para a RSR de 16 +- 4 cmH2O/l/seg/kg. A metodologia utilizada mostrou dados semelhantes aos da literatura e excelente reprodutividade tecnica

Estudo da complacência e resistência do pulmäo e do sistema respiratório do recém-nascido a termo / Study of the indulgence and resistance of the lung and of the breathing system of the newly born to term

Estudou-se 20 Recém-Nascidos a termo, durante o sono e medimos a Complacência e Resistência por 3 diferentes técnicas. Os valores de complacência do Pulmäo (CP) e Resistência do Pulmäo (RP) foram obtidos pelas técnicas de análise convencional(Mead-Wittemberger) e pela técnica de regressäo linear. Os valores da complacência do Sistema Respiratório (CSR) e resistência do Sistema Respiratório (RSR) foram obtidos pela técnica de análise de múltiplas oclusöes.Em 12 Recém-Nascidos foi possível a comparaçäo das 3 diferentes técnicas de análise e de que forma elas se correlacionavam. Apesar das medidas pulmonares serem diferentes das medidas do Sistema Respiratório, a elevada complacência da caixa torácica no Recém-Nascido permitiu a correlaçäo entre ambas medidas. Encontrou-se excelente correlaçäo quando comparamos os valores de CP obtidos pelas técnicas de regressäo linear e de Mead-Wittemberger (r=0.97). Excelente correlaçäo também foi encontrada quando comparou-se a RP por ambas técnicas ( r = 0.98). Quando comparou-se os valores obtidos para CSR pela técnica de múltiplas oclusöes com os valores de CP obtidos pela técnica convencional, encontramos boa correlaçäo (r=0,85). Boa correlaçäo (r=0,85). Boa correlaçäo também foi encontrada quando comparou-se a CSR com a CP obtida pela técnica de regressäo (r=0,83). Já a comparaçäo da RSR com a RP obtidas pelas técnicas de regressäo e convencional näo forneceu correlações significativas. Concluíu-se que CP e RP podem ser adequadamente medidas em Recém-Nascidos a termo, por duas técnicas diferentes. CSR mostrou ser uma boa estimativa da CP. RSR näo correlacionou com RP, näo podendo portanto ser utilizada para estimá-la.