ABSTRACT
Resumen Introducción: La enfermedad de Kawasaki (EK) es una vasculitis sistémica aguda con riesgo de desarrollar aneurismas coronarios. Objetivos: Describir características clínico-epidemiológicas en niños con diagnóstico de EK en Argentina. Analizar factores de riesgo para el desarrollo de complicaciones coronarias (CC). Población y Métodos: Estudio multicéntrico, retrospectivo, transversal, observacional y analítico. Incluyó pacientes bajo 18 años de edad, con diagnóstico de EK en hospitales de Argentina, entre el 1 de enero de 2010 y el 31 de diciembre de 2013. Resultados: N = 193 sujetos. Edad: mediana: 29 meses. Tasa promedio total país 5 casos/10.000 egresos hospitalarios. Presentaron CC 15,5%. Mayor riesgo de CC: Mayor cantidad de días de fiebre al momento de colocación del tratamiento (p = 0,0033); Aumento de: frecuencia cardíaca (p = 0,0021), eritrosedimentación (VSG) (p = 0,005), proteína C reactiva (PCR) (p < 0,0001), leucocitosis (p = 0,0006), neutrofilia (p = 0,0021); Disminución de hematocrito (p = 0,0007) y hemoglobina (p < 0,0001). Asociación con CC: alteraciones cardiológicas no coronarias (ORv10.818); PCR mayor de 68 mg/L (OR = 11.596); leucocitos mayores a 20.000/mm3 (OR= 4.316); y VSG mayor de 64 mm/1° hora (OR = 4.267). Conclusión: La forma de presentación más frecuente fue EK completa, el riesgo de CC fue mayor en varones, menores de 5 años de edad, los factores de riesgo (clínicos y de laboratorio) fueron semejantes a los descritos en la bibliografía.
Background: Kawasaki disease (EK) is an acute systemic vasculitis with a risk of developing coronary aneurysms. Aim: To describe the clinical and epidemiological characteristics of children with EK in Argentina and to analyse the risk factors for the development of coronary's complications (CC). Methods: Multicenter, retrospective, cross-sectional, observational and analytical study. It included patients younger than 18 years of age diagnosed with EK in hospitals in Argentina, between January the 1st, 2010 and December the 31th, 2013. Results: N = 193 subjects. Age: medium: 29 months. Total incidence 5 cases / 10,000 hospital discharges. CC was observed in 15.5% of patients. Increased risk factors for CC: Elevated number of days with fever at the time of treatment placement (p = 0.0033); Increased of: heart frequency (p = 0.0021), erythrosedimentation (ESR) (p = 0.005), C-reactive protein (CRP) (p < 0.0001), leukocytes (p = 0.0006), neutrophils (p = 0.0021); Decreased of hematocrit (p = 0.0007) and hemoglobin (p < 0.0001).Association with CC: non-coronary cardiological alterations (OR = 10,818); PCR greater than 68 mg /L (OR = 11,596); leukocytes greater than 20,000 / mm3 (OR = 4.316); and ESR greater than 64 mm / 1 hour (OR = 4.267). Conclusion: The most frequent form of presentation was complete EK, the risk of CC was higher in males, younger than 5 years old, the risk factors (clinical and laboratory) were similar to those described in the literature.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Coronary Disease/etiology , Coronary Disease/epidemiology , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/epidemiology , Argentina/epidemiology , Seasons , Blood Sedimentation , C-Reactive Protein/analysis , Incidence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Immunoglobulins, Intravenous/therapeutic use , Statistics, Nonparametric , Risk Assessment , Mucocutaneous Lymph Node Syndrome/therapyABSTRACT
Infections after cardiovascular surgery are an important cause of morbidity and mortality. This paper described the study of risk factors associated with development of infections. This is a prospective study, setting in a Hospital JP Garrahan, a tertiary and referral center of Buenos Aires, Argentina. All patients with cardiac surgeries between 1/11/01 to 1/1/ 2002 were included. The median age of p was 30 months (r: 1-212 m), 184 p (53 percent) were boys, 21 percent (75) had underlying disease, being the genetic disorders or undernutrition the most frequent, 56 p (16 percent) had previous surgery, 36 p (10 percent) had received previous antibiotics and 30 (9 percent) of them had previous infection, An ASA score higher than or equal to 3 was found in 308 p (88 percent). Median hospital stay before surgery was 1 day (r1-120 d), 88 p (25 percent) nedeed inotropic support with epinephrine, 147 p (42 percent) needed mechanical ventilation during a median time of 4 days (r: 1-66d).Drainage with thorax opened was done in 339p (97 percent) for a median time of 2 days (r:1-7d). Total hospital stay was between 1 and 120 days (median 5 days). Postsurgical infections developed in 38 of 350p (11 percent). Superficial wound infection in 4 p (1 percent), 5 p (1.5 percent) had deep infection, 3p (1 percent) had mediastinitis and 26 p (7.5 percent) had other nonsurgical infections Eleven p (3 percent) died. By multivariate study underlying diseases (p<0.012) OR 4.22 (CI 1.38-12.8), inotropic support with epinephrine (p<0.027) OR 4.04 (CI 1.17-13.9) and postoperative stay longer than 12 days were found to be risk factors for infections. We concluded that presence of underlying diseases, longer hospitalization and inotropic support were risk factors for infections.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Cardiac Surgical Procedures/adverse effects , Cross Infection/etiology , Argentina , Incidence , Prospective Studies , Risk Factors , Statistics, NonparametricABSTRACT
Antecedentes: enfermedad frecuente en nuestro medio que por sus complicaciones requiere solución quirúrgica. Objetivo: presentar la casuística de nuestro servicio y mostrar la efectividad del método de colgajo de rotación romboidal. Lugar de aplicación: Servicio de Cirugía General del Hospital Padilla de Tucumán. Diseño: estudio restrospectivo. Población: doce pacientes con diagnóstico de quiste pilonidal entre 15 y 28 años tratados entre enero de 1997 y diciembre de 1999. Método: técnica de colgajo de rotación romboidal (técnica de Dufourmentel), drenaje aspirativo y antibioticoterapia. Resultados: se obtuvo el 91,7 por ciento de curación, con una recidiva (8,3 por ciento), se presentó dehiscencia de sutura como complicación menor en 16,6 por ciento de los casos. Conclusión: esta técnica favorece el corto período de hospitalización, con rápida reinserción a la actividad habitual, con escasa recidiva