72-Hour Clinical Pulmonary Infection Score May Have Prognostic Value Among Trauma Patients With Ventilator Associated Pneumonia

Background: Ventilator-associated pneumonia (VAP) is a common, serious nosocomial infection; reduction of morbidity and mortality is achieved by prompt diagnosis and early initiation of appropriate empiric antimicrobial therapy. While Clinical Pulmonary Infection Score (CPIS) on the day of VAPdiagnosis has not been proven a consistently effective device, we postulate the CPIS 72 hours after VAPdiagnosis may serve as a clinical prognostic indicator. The purpose of this study is to assess the potential value of CPIS in trauma patients with VAP. Methods:We performed a retrospective chart review of 50 intubated trauma patients with VAPadmitted to the intensive care unit (ICU) of an urban level-I trauma center from January-December 2013. Patients were consecutively identied via trauma registry, and data were abstracted on demographics; injury severity score (ISS); vital signs; laboratory values; microbiological cultures; ventilator settings; antibiotic therapy; time of VAP diagnosis; outcomes; and survival to discharge. We calculated modied CPIS at initial diagnosis and 72-hours post-diagnosis. Incomplete records were excluded from analysis. Results: Forty-nine patients, 25 females and 24 males, with mean age of 66.1±5.2 years were analyzed. Overall mortality was 18.4% (n=9); mean ISS was 18.3±1.2; mean length of stay (LOS) was 20.7±3 days; mean ICU-LOS was 16.7±3.1 days; mean ventilator days was 15±3.2; mean day-1 CPIS was 5.8±0.5; and mean day-3 CPIS was 4.9±0.6. Multidrug resistant organisms (MDROs) were identied in 26 patients and associated with higher 72-hour CPIS (5.8±0.9 vs 3.7±0.7, p=0.025). 72-hour CPIS <6 was signicantly associated with shorter LOS (16.8±3.1 vs 27.3±5.2 d), shorter ICU-LOS (12.4±2.9 vs 24.1±5.6 d), shorter duration of mechanical ventilation (10.8±3 vs 22.1±5.9 d), and earlier VAPdiagnoses (hospital day 4.4±0.6 vs 7.1±1.4, p<0.001). Conclusions:Initial CPIS calculations after VAPdiagnosis have no clinical value. While not associated with survival to discharge, CPIS calculated 72 hours after VAPdiagnosis may be used as a prognostic indicator for MDROs and improved short-term outcomes for trauma patients.

Fibroangioma nasofaríngeo juvenil. Experiencia en 89 pacientes / Juvenile nasopharyngeal angiofibroma. An experience of 89 patients

El fibroangioma nasojuvenil (FANJ) es un tumor benigno, localmente invasivo, que se presenta en varones púberes y adolescentes. Se manifiesta clínicamente por insuficiencia ventilatoria nasal progresiva y epistaxis. Con el objetivo de describir las características clínico quirúrgicas se realizó un estudio observacional, retrospectivo, transversal de los FANJ intervenidos quirúrgicamente en el período enero 2000 a diciembre 2017 en el Hospital de Pediatría Juan P. Garrahan. Resultados: se incluyeron 89 pacientes con diagnóstico de fibroangioma nasojuvenil intervenidos quirúrgicamente. El 71% de los pacientes menores de 14 años. El síntoma predominante fue epistaxis en el 91% de los casos. El 80,1% (72/89) estaban incluidos en los estadios III y IV de Chandler presentando digitaciones a fosa pterigomaxilar y senos paranasales. El 29,2% (26/89) de los casos presentaba invasión a endocráneo. En el 96% (86/89) se realizó embolización prequirúrgica de las ramas nutricias del tumor. Los abordajes quirúrgicos más utilizados fueron: la vía transantral en el 43,8% (39/89), abordaje de Le Fort 1 en el 21,3% (19/89), endoscópico en el 12,3% (11/89), abordaje combinado con neurocirugía en el 12,3% (11/89) de los pacientes. La recurrencia fue de 33,7% y no hubo pacientes fallecidos. Conclusiones: El fibroangioma nasojuvenil es una patología tumoral que requiere para su resolución un equipo multidisciplinario en instituciones con infraestructura de alta complejidad. El abordaje quirúrgico debe seleccionarse de acuerdo a la localización y extensión tumoral, la efectividad de la embolización previa, la edad del paciente y la experiencia del equipo quirúrgico (AU)

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, locally invasive tumor, occurring in pubertal and adolescent males. Clinically the tumor manifests with progressive nasal obstruction and epistaxis. With the aim to describe the clinical and surgical features, an observational, retrospective, cross-sectional study was conducted in patients with JNA who underwent surgery at Hospital de Pediatría Juan P. Garrahan between January 2000 and December 2017. Results: Overall, 89 patients diagnosed with JNA who underwent surgery were included; 71% were under 14 years of age. The main symptom was epistaxis occurring in 91% of the cases. Of all patients, 80.1% (72/89) were in Chandler stages III and IV with extension into the pterygomaxillary fossa and paranasal sinuses. Intracranial invasion was found in 29.2% (26/89) of the cases. In 96% (86/89), preoperative embolization of the feeding branches of the tumor was performed. The most commonly used surgical approaches were: The transantral approach in 43.8% (39/89), Le Fort 1 in 21.3% (19/89), endoscopic approach in 12.3% (11/89), and an approach combined with neurosurgery in 12.3% (11/89) of patients. Recurrence rate was 33.7% and none of the patients died. Conclusions: Management of JNA a multidisciplinary team at a tertiary care institution. The surgical approach should be selected according to tumor location and extension, effectiveness of previous embolization, the patient age, and expertise of the surgical team (AU)

Tumores nasales congénitos de la linea media / Congenital nasal tumors of the midline in ENT

Las masas nasales congénitas de la línea media se presentan con una frecuencia muy baja ­1/20.000 a 1/40.000 nacidos vivos­. Se trata de hallazgos asintomáticos en el recién nacido y son resultado de anomalías congénitas del desarrollo embrionario, que suelen aparecer como masas en la línea media nasal en un punto cualquiera entre glabela y columela. Estas tumoraciones presentan un riesgo elevado de extensión al sistema nervioso central, lo que es especialmente importante tener en cuenta para prevenir consecuencias tales como la fístula de líquido cefalorraquídeo y/o la aparición de meningitis recidivante. Existen gran cantidad de tumores nasales de la línea media que aparecen en el recién nacido o en el lactante y que constituyen diagnósticos diferenciales de las lesiones congénitas antes descriptas. Describiremos brevemente los más frecuentes según nuestra experiencia. AU

Congenital nasal masses of the midline are very rare ­ 1/20,000 to 1/40,000 live births ­. Nasal tumors are asymptomatic findings in the neonate and are caused by congenital abnormalities during fetal development, usually appearing at the nasal midline between the glabella and columella. These tumors are associated with a high risk of extension to the central nervous system; therefore, it is especially important to prevent the development of a cerebrospinal fluid fistula and/or recurrent meningitis. There is a large number of nasal tumors of the midline in neonates or infants in the differential diagnosis of the above-described congenital lesion. Here we briefly describe the most common nasal tumors seen at our department. AU

Validation of the surgical APGAR score among patients undergoing major surgery at the Chinese General Hospital

Objective: This study sought to validate Surgical APGAR Score in predicting major postoperative complications 30 days after surgery in our hospital setting. Methods: All patients undergoing major general surgery in Chinese General Hospital and Medical Center from March to October 2009 were enrolled. Three intraoperative variables were measured: estimated blood loss (EBL), lowest mean arterial pressure (LMAP) and lowest heart rate (LHR). Base on these three variables, Surgical APGAR Scores were obtained. Resulting data were analyzed and the relationship between the scores and the incidence of major complications evaluated. Results: Eighty patients were enrolled in this study. There was a significant association of incidence of major complications decreased monotonically. The optimum cutoff point was <= 6. At this cutoff point, sensitivity was 80%, specificity was 78.57%, positive predictive value was low at 34.8%, while negative predictive value was high at 96.5%. Conclusion: Results showed that a simple surgical score can be derived from intraoperative data alone that are readily available. It validated that this 10-point scoring system based on estimated blood loss (EBL), lowest mean arterial pressure (LAMP) and lowest heart rate (LHR) can predict group of patients at higher risk of major complications within 30 days of surgery. This system can be a significant tool for prognostification and clinical guide for early intervention of postoperative care in surgery. Key words: estimated blood loss, lowest mean arterial pressure

Granulocytic sarcoma with spinal cord compression in chronic myelogenous leukemia: a case report

We report on a 19-year-old man with a spinal cord compression secondary to granulocytic sarcoma [GS] as the initial presentation of a chronic myelogenous leukemia [CML]. Blastic crisis developed two months later. According to our case report and to the literature, the diagnosis of GS could predict a rapid progression to blastic phase