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1.
Rev. chil. pediatr ; 91(2): 255-259, abr. 2020. graf
Article in Spanish | LILACS | ID: biblio-1098900

ABSTRACT

Resumen: Introducción: El marcapasos diafragmático permite reducir o eliminar la necesidad de ventilación mecánica en pacientes con insuficiencia respiratoria crónica que conservan el eje nervio frénico-diafragma in tacto, siempre que no presenten enfermedad pulmonar intrínseca. Aunque su implantación ha sido practicada por décadas, su uso no está ampliamente difundido, y existe poca literatura pu blicada al respecto, la mayoría relacionada con lesión medular alta y síndrome de hipoventilación central congénito. Objetivo: Describir una experiencia de implantación de marcapasos diafragmático en paciente pediátrico con síndrome de hipoventilación central adquirido. Caso Clínico: Pa ciente femenino con síndrome de hipoventilación central secundario a lesión isquémica de tronco cerebral como resultado de disfunción de válvula de derivación ventrículo peritoneal, motivo por el cual durante 5 años se mantuvo con asistencia de ventilación mecánica intrahospitalaria. A los 7 años de edad se implantó marcapasos diafragmático mediante cirugía toracoscópica, lo que per mitió posterior a un periodo de rehabilitación y acondicionamiento respiratorio el destete de la ventilación mecánica y el egreso hospitalario. Conclusiones: El marcapasos diafragmático es una opción factible, potencialmente segura y costo efectiva para disminuir o eliminar la dependencia de ventilación mecánica y mejorar la calidad de vida en pacientes con síndrome de hipoventilación central adquirido.


Abstract: Introduction: Diaphragmatic pacemaker is a device that reduces or eliminates the need of mechanical ventilation in patients with chronic respiratory failure who keep the phrenic nerve-diaphragm axis intact, as long as they do not present intrinsic lung disease. Although its implantation has been practiced for deca des, its use is not widespread and to date, there is little published literature about it, mostly related to high spinal cord injury and congenital central hypoventilation syndrome. Objective: To describe an experience of diaphragmatic pacemaker implantation in a pediatric patient with acquired cen tral hypoventilation syndrome. Clinical Case: Female patient with central hypoventilation syndrome secondary to ischemic brainstem lesion as a result of ventriculoperitoneal shunt malfunction. For this reason, for 5 years she was supported by inpatient mechanical ventilation. At 7 years of age, a diaphragmatic pacemaker was implanted by thoracoscopic surgery, which allowed, after a period of rehabilitation and respiratory conditioning, mechanical ventilation withdrawal, and hospital dischar ge. Conclusions: Diaphragmatic pacemaker is a feasible, potentially safe, and cost-effective option for decreasing or eliminating mechanical ventilation dependence and improve life quality in patients with acquired central hypoventilation syndrome.


Subject(s)
Humans , Female , Child , Pacemaker, Artificial , Diaphragm , Hypoventilation/therapy , Syndrome , Thoracoscopy , Hypoventilation/etiology
2.
Rev. chil. ter. ocup ; 14(2): 267-276, dic. 2014.
Article in Spanish | LILACS | ID: lil-769009

ABSTRACT

El presente trabajo se propone navegar en las posibilidades que otorgan las ideas sobre el Ser y el Tiempo desarrolladas por Martin Heidegger, como punto de partida para una reflexión ontológica sobre la ocupación, coherente con el ejercicio de la Terapia Ocupacional. Con este propósito, se revisan y contrastan conceptos centrales de la propuesta del autor alemán con el proyecto ampliamente aceptado por la comunidad de Terapeutas Ocupacionales, la naturaleza ocupacional del ser humano de Ann Wilcock. La discusión, además de centrarse en la invitación a los y las terapeutas ocupacionales a profundizar en este tema, se encuentra con una evidente sincronía entre el dasein hedeggeriano y la ocupación, aspectos que resuenan en la noción de becoming de Wilcock.


The present paper pretends to sail through the posibilities given by the notions about Being and Time developed by Martin Heidegger, as a starting point for an ontological reflection about occupation, coherent with the Occupational Therapy practice. For this purpose, core concepts of the German author are revised and contrasted with the project widely accepted in the occupational therapists community, the occupational nature of the human being by Ann Wilcock. The discussion, in addition to focusing on the invitation to the occupational therapists to go deeper into the topic, encounters an evident synchrony between Heidegger’s dasein and occupation, both aspects that resonate in Wilcock’s notion of becoming.


Subject(s)
Humans , Knowledge , Occupational Therapy , Philosophy , Time , Consciousness
3.
Rev. chil. dermatol ; 26(4): 399-403, 2010. ilus
Article in Spanish | LILACS | ID: lil-721802

ABSTRACT

La dermatomiositis se caracteriza por su compromiso cutáneo y muscular, siendo rara su asociación a cánceres seminomatosos y no seminomatosos en un mismo paciente. Se presenta el caso de un paciente de sexo masculino, de 31años, con tres meses de mialgias y eritema heliotropo en cara acompañado de erupción máculo-papular en áreas fotoexpuestas y yuxta-articulares, asociado a un aumento de volumen testicular izquierdo. La CK, beta-HCG, GOT, GPT, LDH, y alfa-feto proteína estaban elevadas. La biopsia muscular informó miositis intersticial y el estudio histopatológico testicular evidenció un cáncer testicular mixto con seminoma, teratocarcinoma y carcinoma embrionario. No presentó metástasis. Se trató con prednisona y orquiectomía, constatándose disminución progresiva del compromiso cutáneo en los meses siguientes a la cirugía. Los reportes publicados enfatizan medir alfa-feto proteína y beta-HCG, y examinar los testículos en pacientes jóvenes con dermatomiositis. Todos los casos publicados presentaron una evolución rápida. La sobrevida está relacionada con el volumen tumoral y la elevación de marcadores. La resolución del cuadro dermatológico dependerá de la sospecha precoz y el oportuno tratamiento de la patología de base.


Dermatomyositis is characterized for skin and muscular involvement, being rare its association with seminomatous and non seminomatous germ cell cancers, both in the same patient. The clinical case is a male patient 31 years old, with a story of three months of mialgies and heliotrope rash in face, and maculopapular lesions in photoexposed and juxta-articular areas, associated with left testicle increased in size. CK, beta-HCG, GOT, GPT, LDH, and alpha-fetoprotein were elevated. Muscular biopsy informed interstitial myositis; the histopathological study of a testicle tissue biopsy showed mixed testicular cancer with seminoma, teratocarcinoma, and embryonal carcinoma. No metastasis were found. He was treated with prednisone and orchiectomy, watching a progressive decrease of the cutaneous involvement over the next months after surgery. Literature reports remark to measure alpha-fetoprotein and beta-HCG, and to exam both testicles in young patients with dermatomyositis. All published cases had a rapid evolution. Survival is related with tumor size and elevation of serum markers. Resolution of the dermatologic features will depend on clinical suspicious and opportune treatment of the cancer.


Subject(s)
Humans , Male , Adult , Dermatomyositis/complications , Dermatomyositis/drug therapy , Testicular Neoplasms/complications , Antineoplastic Agents, Hormonal/therapeutic use , Biopsy , Chorionic Gonadotropin, beta Subunit, Human/analysis , Neoplasms, Germ Cell and Embryonal , Testicular Neoplasms/surgery , Testicular Neoplasms/pathology , Orchiectomy , Paraneoplastic Syndromes , Prednisone/therapeutic use , alpha-Fetoproteins/analysis
4.
Rev. chil. pediatr ; 79(6): 580-592, dic. 2008. tab
Article in Spanish | LILACS | ID: lil-522216

ABSTRACT

Non-invasive ventilation (NIV) has extended its use in pediatric setting. Besides acute respiratory conditions, it is also used in chronic diseases associated to ventilatory failure. In the acute setting, PICU constitutes the natural scenery. In chronic conditions, therapy is transferred home as a multidisciplinary program already available in our country. The objective of this review is an update applying respiratory physiology, technical and clinical issues necessary for choosing and using accurately NIV in both acute and chronic settings.


La asistencia ventilatoria no invasiva (AVNI) es cada vez más utilizada en pacientes pediátricos; tanto en patologías respiratorias agudas, como en enfermedades crónicas que comprometen la bomba respiratoria en forma primaria o secundaria. En el escenario agudo, el paciente requiere de manejo intrahospitalario en Unidades de Paciente Critico (UPC), sin embargo en el paciente crónico su rol se extiende al hogar a través de programas multidisciplinarios integrales disponibles en nuestro país. El presente artículo de actualización pediátrica entrega las bases fisiológicas de la AVNI, sus diferentes modalidades, alternativas de interfases, sistemas de humedificación, aspectos de oxigenación y terapia broncodilatadora. Se entregan aspectos prácticos para la selección y empleo de la AVNI en el escenario agudo y crónico.


Subject(s)
Humans , Child , Respiratory Insufficiency/therapy , Respiration, Artificial/methods , Acute Disease , Chronic Disease , Monitoring, Physiologic , Patient Care Team , Patient Selection , Residential Treatment , Respiration, Artificial/adverse effects , Treatment Failure
5.
Rev. chil. pediatr ; 78(5): 494-499, oct. 2007. ilus, tab
Article in Spanish | LILACS | ID: lil-482862

ABSTRACT

Background: Bronchopulmonary sequestration is a rare congenital lung malformation, charactarized by an abnormal segment of bronchopulmonary tisue, irrigated by an anomalous systemic artery. Objective: To report the clinical course of an infant with an intralobar bronchopulmonary sequestration and review the most relevant aspects of this lung malformation. Case-report: A six months-old infant, treated for a pneumonia involving the right lower lobe, with persistence of the consolidation image for more than six weeks. Because of a computed tomography (CT) that showed an image suggesting a bronchopulmonay sequestration, the infant was scheduled for surgery, confirming the presence of the intralobar type of the malformation, which was removed without incidents. Conclusion: Bronchopulmonary sequestration is a rare congenital lung malformation, but it has to be considered in the presence of recurrent pneumonia or persisting consolidation images.


Introducción: El secuestro pulmonar es una malformación congénita poco frecuente, caracterizada por un segmento anormal de tejido broncopulmonar irrigado por una arteria anómala de origen sistémico. Objetivo: Presentar el caso de un lactante menor con un secuestro pulmonar intralobar y revisar los aspectos más relevantes de este tipo de malformación congénita. Caso Clínico: Lactante menor de 6 meses de edad, tratada por una neumonia del lóbulo inferior izquierdo, con persistencia de la imagen de condensación por más de 6 semanas. Por este motivo se le realizó una Tomografía axial computada (TAC) que mostró una imagen sugerente de secuestro pulmonar, por lo que fue sometida a cirugía, corroborándose la variedad intralobar de esta malformación, la cual fue resecada sin inconvenientes. Conclusiones: El secuestro pulmonar es una malformación congénita poco frecuente, pero que se debe considerar ante la presencia de neumonías recurrentes o imágenes de condensación persistentes.


Subject(s)
Humans , Female , Infant , Bronchopulmonary Sequestration , Diagnosis, Differential , Radiography, Thoracic , Bronchopulmonary Sequestration/surgery , Tomography, X-Ray Computed
6.
Rev. méd. Chile ; 131(9): 1031-1036, sept. 2003.
Article in Spanish | LILACS | ID: lil-356009

ABSTRACT

BACKGROUND: The nutritional impact of CONIN nutritional recovery centers must be evaluated, considering the current epidemiological situation in Chile and the new therapeutic focus giving more emphasis to ambulatory treatment. AIM: To analyze the nutritional status of children treated at traditional CONIN centers, the reason for their admission and the factors associated with changes of weight for age index during the hospitalization. PATIENTS AND METHODS: During the year 2000, the records of 561 patients discharged from the traditional CONIN centers throughout the country were retrospectively analyzed. The changes in weight and height during admission and the possible factors influencing these changes, were determined. RESULTS: The average lapse of stay was 3.9 months; 78 per cent of children had concomitant diseases at admission and 18.7 per cent required to be admitted in a general hospital. One third was admitted with normal weight or even overweight according to the weight for age index, and 31.1 per cent was undernourished. During admission in CONIN, the number of undernourished patients was reduced by 50 per cent, while the proportion of children with normal nutritional status increased by 15 per cent (p < 0.001). On admission, 7.8 per cent of children had a low height for age, evidencing a chronic undernutrition. This figure did not change on discharge. The increase of weight/age and weight/height was substantially higher in children with a greater initial deficit (p < 0.001). CONCLUSIONS: Admission to a CONIN center had a low nutritional impact, and a high risk of a lengthy stay. The most favorable impact could be appreciated in children that were effectively undernourished. Admissions are motivated mainly by social issues, over and above nutritional problems.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Nutritional Status , Length of Stay , Infant Nutrition Disorders/diagnosis , Patient Admission , Nutrition Assessment , Retrospective Studies
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