[Postoperative management of postpneumonectomy pulmonary edema in a patient with ostium secundum atrial septal defect]. / Edema postneumonectomía en paciente con comunicación interauricular tipo ostium secundum. Manejo postoperatorio.

We report the case of a 55-year-old woman who underwent right pneumonectomy for invasive squamous cell carcinoma. At 48 hours after surgery she developed severe dyspnea and hypoxemia that required reintubation and a progressively higher inspired oxygen fraction. A radiograph demonstrated pulmonary edema; echocardiography revealed an ostium secundum atrial septal defect with increased flow to the lung and severe pulmonary hypertension. Emergency percutaneous closure of this defect was carried out. This case report describes the management and treatment of postpneumonectomy pulmonary edema and atrial septal defect, as well as the circumstances that favor their development. We recommend that cardiac defects be investigated and possible treatment be considered prior to pneumonectomy.

[Propofol in continuous perfusion as anesthetic in experimental surgery in the rabbit]. / Propofol en perfusión continua como anestésico en cirugía experimental del conejo.

OBJECTIVES: To study anesthesia with intramuscular ketamine chlorohydrate and continuous intravenous perfusion of propofol (2.6 phenyl diisopropyl) in 30 white New Zealand rabbits undergoing tracheal and vascular surgery and experimental bronchoscopy without mechanical ventilation. MATERIAL AND METHOD: The animals were monitored by transcutaneous pulse oximetry and were sedated before canalization of the auricular vein. Oxygen was administered under a bell at a rate of 5 l/min. Variables recorded were heart and respiratory rates, oxygen saturation, blink reflex, and movements during surgery. The anesthetic protocol consisted of sedation (intramuscular ketamine chlorohydrate 50 mg/kg), followed by induction (intravenous propofol 3 mg/kg), and maintenance with intravenous infusion of diluted propofol in 2 phases as follows: a loading dose of 1.2 mg/kg/min first, followed by maintenance with 0.9 mg/kg/min propofol in dextrose at 5% concentration (4 mg/ml). RESULTS: The procedure afforded adequate anesthesia for surgery lasting up to 70 min. Vital signs were stable in all animals. The perfusion rate was modified during surgery in 8 animals, in 5 because of superficial anesthesia and in 3 because of respiratory depression. Respiratory rate was the only parameter that was significantly correlated with depth of anesthesia and propofol dose. Postanesthetic recovery was rapid in all animals. No cases of heart/respiratory failure or death occurred. CONCLUSIONS: The proposed method is useful for anesthetizing the rabbit, as it renders mechanical ventilation unnecessary. Only simple monitoring of respiratory rate is required.

[Satisfaction of parents of children undergoing outpatient surgery]. / Satisfacción de los padres de niños intervenidos con cirugía sin ingreso.

BASIS: The objectives of the study are: 1. Know the grade of satisfaction of the parents of children operated in a program of surgery without admission (CSI). 2. Compare it with another program of surgery with admission (CCI). 3. Know the outputs of reentry and complications of both programs. MATERIAL AND METHOD: 95 children were operated in a program of CSI. They were elected 95 children operated with CCI of similar characteristic. A questionnaire in a type Likert scale was sent for mail to the parents to value diverse looks of the satisfaction: Information, deal, perceived control, security, hostelry and global satisfaction. The questionnaire also picked up social-demographics and cultural data. OUTPUTS: The rate of the answer was from the 83% in the program of CSI and 82% in the CCI. The global satisfaction was over 90% in both programs. They met differences significant in the sensation of insecurity, more frequent in the parents of children operated with CSI (30%) that with CCI (11%). The reentry and complications rate of the evaluated program are similar to other programs of CSI.

[Fluid dynamics in the Port-a-Cath Low Profile: therapeutic uses]. / Dinámica de fluidos en el Port-a-Cath Low Profile: aplicaciones terapéuticas.

The treatment of infection and obstruction in totally implantable central venous access catheters is based on the administration of medication into the system. Injected medication may be diluted in the portal which acts as a dead space in the line. We have studied the dynamic of fluids in the Low Profile Port-a-Cath, and developed an infusion-suction technique with double syringe to achieve high concentrations in the system with minimum repercussion in the vascular space. This procedure can be applied both in the treatment of infection with high-dose local antibiotics and in total or partial obstructions.

[Cortical fracture of the sternum in a child: an infrequent case]. / Fractura cortical de esternón en la infancia: un caso excepcional.

We report the case of a six-year-old girl who suffer an isolated sternal fracture due to hyperflexion of the thorax (while she was playing on a jumping-bed). On clinical examination, only slight tenderness and pain with compression of sternum was found. Chest X-ray demonstrated a fracture of the body of the sternum without other findings. The patient was admitted, observed during 12 hours with ECG monitoring and discharged because no cardiac or pulmonary pathology appeared. We present this case because fracture of the sternum in a child is rare, especially if road-traffic accident with seat belt injury is not implicated as a cause.

[Rupture of a gastrostomy button. Importance of choosing the adequate material]. / Rotura del botón de gastrostomía. Importancia de la elección del material.

PEG is a safe, effective and widely used modality for nutritional andpharmacological enteral support in children. Rupture of the gastrostomy button during replacement is a very infrequent complication that may be avoided by choosing the adequate tube.

Wet umbilicus caused by pancreatic heterotopia in urachal remains.

Drainage from the umbilicus may be due to the presence of structures derived from the vitelline duct or urachus, granulomas, ectopic tissue, or poor hygienic practice. This paper discusses the case of a 6-month-old infant with a wet umbilicus caused by ectopic pancreatic tissue, in urachal remains. No similar cases have been found in the literature.