Indirect immunofluorescent assay (IFA) in buffy coat as a rapid diagnostic test for invasive candidiasis.

In order to have a diagnostic test for invasive candidiasis, an immunofluorescent assay (IFA) in buffy coat was developed and evaluated. This test was compared to buffy coat culture and blood culture. The study was divided into two parts: evaluation of the diagnostic test in a rabbit model, and for diagnosis in patients at high risk for invasive candidiasis. Part I: Rabbits were experimentally infected. Of 13 rabbits with disseminated candidiasis blood was drawn from central venous catheter and from peripheral veins. From catheters, Candida was detected in 13/13, 10/13 and 8/13, by buffy coat culture, IFA, and blood culture, respectively. From peripheral veins, Candida was detected in 10/10 by buffy coat cultures, in 6/10 by IFA and in 3/10 by blood cultures. The gold standard was histopathological diagnosis; sensitivity for IFA was 60% with peripheral blood and 76% with catheter blood samples. Part II: IFA and blood cultures were compared in clinical samples from hospitalized children. Forty patients were included. Candida was isolated from blood cultures in four patients whereas IFA detected Candida in 22 patients. Differences were statistically significant (p < 0.05). We conclude that IFA in buffy coat smears is a reliable test to detect candidemia, and would be a useful tool to help physicians with treatment decisions with amphotericin B.

[The Mortality Committee: a hospital need]. / El Comité de Mortalidad: una necesidad hospitalaria.

Mortality Committees are multidisciplinary teams whose function is to analyze preventable causes of death in order to decrease the death rate, to contribute to the education of medical and paramedical staff and also to advise the hospital authorities in medical and administrative decision-making. In this paper we discuss the activities of the Mortality Committee of the Hospital de Pediatria from May 1989 to May 1991. The review comprised 202 death cases occurred during this period, and was carried out by the medical personnel involved in attending those cases while alive. In 42.5% of these cases the review was supplemented by the necropsy results. Patients' personal data, referral source, status on admission, principal disease, direct cause of death, adequacy of laboratory test and other studies, clinical/pathological correlation and suggestions to improve medical care are discussed. We suggest for every hospital the convenience of having this committee in order to improve the quality of medical care.

[The degree of agreement of the clinical and the histopathological diagnoses in a tertiary medical care pediatric hospital]. / Grado de concordancia del diagnóstico clínico con el histopatológico en un hospital pediátrico de tercer nivel de atención médica.

In Pediatric Hospital, from the National Medical Center, of the Mexican Institute of Social Security were analyzed 96 histological pieces: 59 biopsies, 21 surgical material and 16 slides. There were showed the agreement rate between clinical diagnosis and the end histopathological report from the Pathology Department. The higher correlation rate were with biopsies (83%) and surgical material (81%) and the lowest rate were with slides samples (69%). There were not statistical difference in the 3 study groups (P greater than 0.05). The overall concordance with the clinical diagnosis were 82%. The overall concordance with the 3 study groups were 80%. It is concluded what agreement rate was satisfactory in biopsies and surgical material and the agreement rate measure is an actual parameter in evaluation of clinical competence and also in the evaluation of medical care quality.

[Evaluation of primary cicatrization of anastomosis of small intestine (experimental study in guinea pigs)]. / Evaluación de cicatrización primaria en anastomosis de intestino delgado (estudio experimental en cuyos).

The healing process carried out during the first 72 hours of the anastomotic line of the small intestine has not been satisfactorily studied. This is a time during which intestinal transit is evaluated and oral feeding is given without being really sure whether there is resistance to rupture and if the open surgical technique favors local infection. For this study, 120 guinea pigs submitted to end-to-end anastomosis were used, 30 with continuous sutures and 30 with separate stitches, who were examined 24, 48 and 72 hours after the surgery, plus another group similarly evaluated immediately after the surgery, finding that rupture resistance is greater immediately after surgery than 48 or 72 hours later and that in these, the inflammatory process is greater and a more positive number of cultures are found. The antibiotic orally and parenterally administered did not do away with the infection but did limit further complications.

[Congenital nephrotic syndrome of Finnish type (report of a case)]. / Síndrome nefrótico congénito de tipo finlandés (presentación de un caso).

The case reported was that of a 3-month-old infant without important history. The onset of the disease took place one week before admission with edema, abdominal distention, diarrhea and vomiting. At the physical examination, he showed anasarca with important ascites and a right pneumonic process. The laboratory tests reported anemia, massive proteinuria, hypocalcemia, hypocomplementemia and drop of IgG. A renal biopsy showed cystic dilatation of proximal and distal tubuli. The electronic microscopy, fusion of podocytes and the immunoflorescence, focal deposits of IgG and fibrin. The management was difficult and the course insidious. Death followed septicemia 38 days after admission. The hereditary, etiopathogenetic and clinical characteristics are discussed and compared with other national and foreign reports.

[Congenital posterolateral diaphragmatic hernia]. / Hernia diafragmática posterolateral congénita

Eighty-four cases of posterolateral diaphragmatic hernia in children are reviewed. The most frequent signs were respiratory insufficiency, cyanosis and costal indrawing. The diagnosis was clinically established in over one half of the cases. In most of the patients, the studies showed respiratory acidosis. Also, radiological studies showed, in most of the cases, elevation of the hemidiaphragm with basal opacity of the hemithorax. For surgical treatment, the choice route was the abdominal. Overall mortality reached 37%.