Use of pedicled flaps after oncologic resections in pediatric patients.

The aim of this study is to review the indications of pedicled flaps and analyze the results. A observational retrospective study of under 18-year-old oncology patients who required reconstructive surgery with pedicled flaps between 2011 and 2022 was performed. Demographic and clinical variables, indications, complications, and outcomes were collected. 236 patients were reviewed and 13 met inclusion criteria, eight girls and five boys (mean age: 10.6 years). Indications were Ewing's sarcoma (5), osteosarcoma (5), neuroblastoma, desmoid tumor, and neurofibroma. Preoperative PET-CT, MRI and bone scintigraphy were performed. The flaps were used on costal and extremity reconstruction: latissimus dorsi (5), pectoralis (2), medial gastrocnemius (2), combined latissimus dorsi, trapezius and serratus muscle, biceps femoris, fascio-neuro-cutaneous saphenous and cutaneous advancement-rotation. Two were performed on allograft and eight on prosthesis. All allowed immediate and complete closure. Six patients received intraoperative radiotherapy. One flap infection and two vascular complications were reported, a total necrosis, which required a new flap, and a partial necrosis, treated with a local plasty. Chemotherapy was resumed after 21 days (15-31). Mean follow-up time was 5.34 years. Flaps are an effective therapeutic option allowing reconstruction of large defects after pediatric oncologic surgeries. The most frequent complication was vascular.

Chronic Q Fever as Recurrent Osteoarticular Infection in Children: Case Report and Literature Review.

Q fever osteomyelitis has been rarely reported in children. This infection has an unclear pathophysiology and the optimal therapy is unknown. We report a 2-year-old girl with Coxiella burnetti recurrent multifocal osteomyelitis: femur, metatarsal, cuneiform, and calcaneus. We highlight the complicated diagnosis and management of this case and the importance of considering Q fever in children with chronic-recurrent multifocal osteomyelitis.

Starch as a risk factor for increased trans surgical bleeding in total hip arthroplasty.

OBJECTIVE: Establish whether the use of starch in hip arthroplasty is a risk factor for excessive surgical bleeding and requirement of red blood cell transfusion. METHOD: Analytical observational retrospective study in 240 patients who underwent primary total hip arthroplasty from January 2015 to January 2016. Two groups were formed: starch (94 patients) and non-starch (146 patients). Age, sex, body mass index, preoperative and postoperative hemoglobin, red cell transfusion and surgical bleeding was analyzed. RESULTS: Starchy group had increased risk of excessive surgical bleeding (OR: 3.58; 95% CI: 2.05- 6.26) and red blood cells transfusion (OR: 3.12; 95% CI: 1.76 -5.5). In the starch group average surgical bleeding was 396 ml (SD: ± 234.94) and a decrease in hemoglobin of 4.6 g/dl (SD± 1.38). The control group had an average bleeding of 271.8 ml (SD: ± 139.22) and decrease in hemoglobin of 3.34 g/dl (SD: ± 1.4). DISCUSSION: The starch group had higher surgical bleeding and required more often red blood cells transfusion than the non-starch group. We suggest to take in account the possible complications related to the use hydroxyethyl starch.

OBJETIVO: Determinar si el uso de almidón en la artroplastia de cadera es un factor de riesgo para el sangrado transquirúrgico excesivo y el uso de concentrados eritrocitarios. MÉTODO: Estudio retrospectivo observacional analítico de 240 pacientes sometidos a artroplastia total de cadera primaria desde enero de 2015 hasta enero de 2016. Se integraron dos grupos: almidón (94 pacientes) y no almidón (146 pacientes). Se analizaron la edad, el sexo, el índice de masa corporal, la hemoglobina prequirúrgica y posquirúrgica, el uso de concentrados eritrocitarios y el sangrado transquirúrgico. RESULTADOS: El grupo con almidón tuvo mayor riesgo de sangrado transquirúrgico excesivo (odds ratio [OR]: 3.58; intervalo de confianza del 95% [IC 95%]: 2.05- 6.26) y de transfusión de concentrados eritrocitarios (OR: 3.12; IC 95%: 1.76-5.5). En el grupo con almidón hubo una media de sangrado transquirúrgico de 396 ml (desviación estándar [DE]: ± 234.94) y una disminución de la hemoglobina de 4.6 g/dl (DE: ± 1.38); en el grupo de no almidón hubo una media de sangrado de 271.8 ml (DE: ± 139.22) y una disminución de la hemoglobina de 3.34 g/dl (DE: ± 1.4). DISCUSIÓN: Los pacientes con almidón presentaron mayor sangrado transquirúrgico y requirieron en más ocasiones la transfusión de hemoderivados que los del grupo control, por lo que sugerimos considerar las posibles complicaciones relacionadas con el uso de hidroxietilalmidón.

[Cognitive behavioral treatment in the integral management of obesity in adolescents]. / Terapia cognitivo-conductual en el manejo integral de la obesidad en adolescentes.

OBJECTIVE: Obesity in children and adolescents is associated to a morbidity that has increased significantly. It has become a public health problem around the world. The objective of this paper was to evaluate the efficacy of the cognitive behavioral treatment strategy in the comprehensive management of obesity in adolescents. METHODS: Double blind, randomized, and controlled intervention study, of four months of follow-up, with a total of 115 obese adolescents, aged 12 to 16 years. The intervention group received cognitive behavioral treatment strategy, as well as advise on diet and exercise. At the same time, the control group only received advise on diet and exercise. RESULTS: The percentage of adolescents who showed adherence to diet was 73.7 % versus 41.4 %, (p = 0.0009) and to exercise, 61.4 % versus 19.0 %, (p < 0.0005); compared with the control group, the intervention group was significantly higher. A total of 10 adolescents (17.5 %) in the intervention group and 26 (44.8 %) in the control group dropped-out (p = 0.003). Despite there were significant differences between groups, adolescents in the intervention group exhibited a higher and sustained decrease in body weight, body mass index, as well as in the body fat percentage. CONCLUSIONS: The cognitive behavioral treatment strategy improves adherence and decreases desertion of the weight reduction program in adolescents.

INTRODUCTIÓN: la obesidad en niños y adolescentes y la morbilidad que se le asocia se han incrementado significativamente, lo cual se ha convertido en un problema de salud pública. El objetivo de este estudio fue evaluar la eficacia de la terapia cognitivo-conductual (TCC) en el manejo integral de la obesidad en adolescentes. MÉTODOS: estudio de intervención, aleatorio, doble ciego, controlado, de cuatro meses de seguimiento, al que se integraron 115 adolescentes obesos de 12 a 16 años de edad. El grupo de intervención recibió TCC como terapia coadyuvante, así como indicaciones de dieta y apoyo para el desarrollo de ejercicio. El grupo control solo recibió indicaciones de dieta y apoyo para el desarrollo de ejercicio. RESULTADOS: el porcentaje de adolescentes que se adhirieron a las indicaciones de dieta (73.7 % frente a 41.4 %, p = 0.0009) y ejercicio (61.4 % frente a 19.0 %, p < 0.0005) fue significativamente mayor en el grupo que recibió TCC. En este grupo se registraron 10 pérdidas (17.5 %) y en el grupo control 26 (44.8 %), p = 0.003. Aun cuando hubo diferencias significativas entre los grupos, en los adolescentes que recibieron TCC se apreció una disminución mayor y sostenida tanto en el peso corporal y el IMC como en el porcentaje de grasa total. CONCLUSIÓN: la TCC mejora la adherencia y disminuye la deserción de un programa para reducción de peso en adolescentes.

Attenuation of methamphetamine seeking by the mGluR2/3 agonist LY379268 in rats with histories of restricted and escalated self-administration.

Recent findings implicate group II metabotropic glutamate receptors (mGluR(2/3)) in the reinforcing effects of psychostimulants and have identified these receptors as potential treatment targets for drug addiction. Here, we investigated the effects of mGluR(2/3) stimulation on cue- and drug-primed reinstatement in rats with different histories of methamphetamine (METH) self-administration training, under two conditions: 16 daily sessions of short access (90 min/day, ShA), or 8 daily sessions of short access followed by 8 sessions of long access (6 h/day, LgA). Following self-administration and subsequent extinction training, rats were pretreated with the selective mGluR(2/3) agonist LY379268 (variable dose, 0-3 mg/kg), exposed to METH-paired cues or a priming injection of METH (1 mg/kg), and tested for reinstatement of METH-seeking behavior. LgA rats self-administered greater amounts of METH during the second half of training, but when pretreated with vehicle, ShA and LgA rats showed cue- and drug-primed reinstatement at equivalent response rates. However, LgA rats demonstrated greater sensitivity to mGluR(2/3) stimulation with attenuated responding during cue-induced reinstatement after 0.3 mg/kg and higher doses of LY379268, whereas ShA rats decreased cue-induced reinstatement behavior following 1.0 mg/kg and 3.0 mg/kg LY379268. Additionally, both LgA and ShA rats exhibited decreased METH-primed reinstatement behavior following 0.3 mg/kg and higher doses of LY379268. A separate group of control rats was trained to self-administer sucrose pellets, and demonstrated attenuated cue-induced sucrose-seeking behavior following 1.0 and 3.0 mg/kg LY379268. Together, the results indicate that LY379268 has differential attenuating effects on cue-induced reinstatement behavior in rats with different histories of METH intake. This article is part of a Special Issue entitled 'Metabotropic Glutamate Receptors'.

Positive Allosteric Modulation of mGluR5 Accelerates Extinction Learning but Not Relearning Following Methamphetamine Self-Administration.

Recent studies have implicated glutamate neurotransmission as an important substrate for the extinction of conditioned behaviors, including responding for drug reinforcement. Positive allosteric modulation of the type-5 metabotropic glutamate receptor (mGluR5) in particular has emerged as a treatment strategy for the enhancement of extinction of drug-motivated behaviors. Here, we investigated the effects of the mGluR5 positive allosteric modulator CDPPB, a compound known for its cognitive enhancing effects in rodents, on extinction learning in rats with different histories of methamphetamine (METH) training. Rats were trained to self-administer METH under two conditions: 16 daily sessions of short access (90 min/day, ShA), or eight daily sessions of short access followed by eight sessions of long access (6 h/day, LgA). Control rats self-administered sucrose pellets in daily 30 min sessions. Next, rats were administered vehicle or 30 mg/kg CDPPB prior to seven consecutive daily extinction sessions, subjected to additional extinction sessions to re-establish a post-treatment baseline, and then tested for reinstatement of behavior in the presence of METH- or sucrose-paired cues. Rats were then subjected to a second series of extinction sessions, preceded by vehicle or 30 mg/kg CDPPB, and an additional test for cue-triggered reinstatement. CDPPB treatment resulted in a more rapid extinction of responding on the active lever, especially in the early sessions of the first extinction sequence. However, treatment effects were minimal during subsequent cue reinstatement tests and non-existent during the second series of extinction sessions. Rats with histories of ShA, LgA, and sucrose training expressed similar behavioral sensitivities to CDPPB, with LgA rats demonstrating a modestly higher treatment effect. Positive allosteric modulation of mGluR5 may therefore have some beneficial effects on efforts to facilitate extinction learning and reduce methamphetamine seeking.

Irreducible 'ulled elbow' report of two cases and review of the literature.

Subluxation of the radial head is a common injury in young children. It occurs after longitudinal traction on the extended arm with the forearm in pronation. Diagnosis is made from history and clinical presentation. Closed reduction achieved by supination and flexion or by hyperpronating the affected arm can usually restore normal anatomy satisfactorily. Rarely, it requires open reduction. There are very few cases in the literature that have required open reduction and no article shows intraoperative photographs. We present two cases of delayed diagnosis owing to an atypical clinical history that required open reduction.

Results after treatment of traumatic knee dislocations: a report of 26 cases.

BACKGROUND: A retrospective study was carried out with all the cases of traumatic dislocation of the knee joint treated in our institution between 1988 and 1998. METHODS: In most cases (81%), the dislocation was reduced under general anesthesia and early surgical repair of damaged structures was performed as each case required. In five cases, the treatment was conservative because of associated skeletal and visceral injuries that made immediate surgery inadvisable. RESULTS: Peroneal nerve palsy (23%) and popliteal artery disruption (7.5%) were the most frequent early complications. The most common sequelae were instability (85%) and limp (50%). Early operative repair of all damaged structures was associated with the best functional result (55%). Nonoperative treatment was associated with 100% unsatisfactory results, and these patients are waiting for a second operation to treat the sequelae. CONCLUSION: Operative treatment makes possible the recovery of structures that provide enough stability to perform day-to-day activities in the majority of cases.