[Toxic Megacolon: A rare complication of chronic constipation. Three Pediatric Cases]. / Megacolon Tóxico: Complicación infrecuente de la constipación crónica. A propósito de 3 casos pediátricos.

INTRODUCTION: Chronic constipation is a frequent pathology in the pediatric age that affects the quality of life of pa tients and their families. Its management is usually complex and long associated with poor adheren ce. Toxic megacolon is a serious, potentially lethal disease when chronic constipation is left untreated or poor adherence to treatment. OBJECTIVE: To report 3 pediatric cases of toxic megacolon as a com plication of poorly managed chronic constipation. CLINICAL CASES: Three males patients, aged 6 to 13 years, with a history of chronic constipation and poor adherence to treatment are discussed. They were admitted to the emergency department with clinical findings of toxic megacolon (intestinal dilation and signs of systemic toxicity). Given their condition, all patients required management in the critical patient unit (CPU) and early surgical intervention, undergoing ostomy. All presented fa vorable outcome, performing stoma reversal surgery between 8-24 months later. In all cases, organic cause of the constipation was ruled out. CONCLUSIONS: Toxic megacolon is an infrequent but highly morbid and potentially lethal disease. It requires a high index of suspicion as well as multidisciplinary medical-surgical management.

Encefalitis autoinmune por pembrolizumab en anciano con carcinoma no microcítico avanzado de pulmón. Caso clínico / Pembrolizumab-associated autoimmune encephalitis in an elderly patient with advanced non-small cell lung cancer. A clinical case

Los objetivos terapéuticos en el paciente geriátricoson la mejora de su calidad de vida y de su capacidadfuncional frente al mero incremento de su supervivencia. En patología neoplásica, la decisión de iniciar tratamiento curativo, especialmente inmunoterapia, deberealizarse tras una completa valoración de los riesgospotenciales. El paciente geriátrico es más susceptiblea desarrollar reacciones adversas y de mayor gravedadque el paciente más joven.Se presenta el caso de un anciano octogenario concarcinoma no microcítico pulmonar que desarrolló toxicidad neurológica tras tratamiento con pembrolizumab. Se realiza un diagnóstico diferencial de encefalitisy una revisión de los casos de encefalitis autoinmunepor pembrolizumab para mejorar nuestro conocimiento de esta infrecuente toxicidad. El trabajo interdisciplinar y la valoración geriátrica integral son elementosesenciales para prevenir el deterioro funcional del anciano.(AU)

Therapeutic objectives for the geriatric patient areimprovement of quality of life and functional capacityrather than a mere increase in survival. In neoplasticdisease, the decision to initiate administration of curative therapies, especially immunotherapy, shouldbe taken only after any potential risks have been takeninto account. Geriatric patients are more susceptibleto developing more serious adverse reactions than theyounger population.We report the case of an octogenarian patient withnon-small cell lung cancer who developed neurologictoxicity following pembrolizumab therapy. We carryout a differential diagnosis of encephalitis and providea literature review of pembrolizumab-associated au-toimmune encephalitis cases in order to improve ourknowledge of this unusual toxicity. An interdisciplinaryapproach and comprehensive geriatric assessment areessential components to prevent functional decline inthe elderly.(AU)

[Pembrolizumab-associated autoimmune encephalitis in an elderly patient with advanced non-small cell lung cancer. A clinical case].

Therapeutic objectives for the geriatric patient are improvement of quality of life and functional capacity rather than a mere increase in survival. In neoplastic disease, the decision to initiate administration of curative therapies, especially immunotherapy, should be taken only after any potential risks have been taken into account. Geriatric patients are more susceptible to developing more serious adverse reactions than the younger population. We report the case of an octogenarian patient with non-small cell lung cancer who developed neurologic toxicity following pembroli-zumab therapy. We carry out a differential diagnosis of encephalitis and provide a literature review of pembrolizumab-associated auto-immune encephalitis cases in order to improve our knowledge of this unusual toxicity. An interdisciplinary approach and comprehensive geriatric assessment are essential components to prevent functional decline in the elderly.

Geometry influence on the transmission spectra of dielectric single layers of spheres with different compactness.

The transmission of spectra of different dielectric spheres single layer arrangements has been measured. High dielectric permittivity (epsilon=7) spheres of several millimeters of diameter were used to build the samples whose transmission was measured in the microwave range. The behavior of lattices arranged in square and triangular geometries have been compared in a number of different compactness cases. The same patterns measured have also been calculated by finite-difference time-domain (FDTD) method. Spectra from different geometrical arrangements of the same compactness (measured with the same filling fraction value) are very similar in some cases. Based on the level of similarity we propose three compactness regions. The high compactness region, where the structure effect is important, presents spectra clearly different for the two geometries. In a medium compactness region spectra are almost identical, suggesting a dominant effect of single sphere effects. Finally, in the low compactness region, the spectra from the two geometrical configurations diverge again as the Bragg diffraction values are approached.

Retirada de catéter epidural en un paciente con doble antiagregación / Removal of an epidural catheter from a patient receiving anticoagulant and antiplatelet therapy

Describimos el manejo de la anticoagulación y laantiagregación para la reducción de riesgo de hematomapor la retirada de un catéter epidural. El problema seplanteó en el postoperatorio de una cirugía vascularmayor complicada con un infarto agudo de miocardioque requirió doble antiagregación tras la implantaciónde un stent coronario(AU)

We describe the management of anticoagulant andantiplatelet therapy to reduce the risk of hematoma onremoval of an epidural catheter. The situation arose followingmajor vascular surgery complicated by an acutemyocardial infarction that required anticoagulant andantiplatelet therapy following implantation of a coronarystent(AU)

Role of the home environment in rhinoconjunctivitis and eczema in schoolchildren in Pamplona, Spain.

BACKGROUND AND OBJECTIVE: Indoor air quality has become an important factor for sensitization and development of allergic diseases because of increased time spent in homes. We aimed to analyze the possible home-condition risk factors for allergic rhinoconjunctivitis, atopic eczema, and severe disease in schoolchildren aged 5 through 8 years. MATERIAL AND METHODS: The parents of 3360 school children in Pamplona, Spain in the 5-8-year-old age bracket answered questions about rhinitis and eczema symptoms from the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). The instrument contained additional questions about current home conditions related to mold and dust exposure and about conditions in the first year of life. Associations between the allergic diseases and early and current exposure were studied with chi(2) tests and bivariate and multivariate logistic regression. RESULTS: Exposure to certain home conditions related to molds and dust in the first year of life increased the risk of allergic disease, but having good isolating windows in the first year of life protected against allergic rhinoconjunctivitis and severe atopic eczema. Some current home conditions were also related to an increased risk of current allergic disease; severe atopic eczema was more common among children with single glazing over the bedroom window. CONCLUSION: Current and first-year-of-life home conditions related to dust and mold exposure should be controlled because they influence the prevalence of allergic rhinoconjunctivitis and atopic eczema diseases. Moreover, having a double-glazed window currently and in the first year of life seems to protect against these diseases.

Uso de ropivacaína nebulizada en un paciente con obstrucción distal de la vía aérea / No disponible

No disponible

A comparison of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block in the popliteal fossa.

BACKGROUND: The purpose of this study was to compare anesthetic efficacy and postoperative analgesia of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block in the popliteal fossa (popliteal block). METHODS: A prospective, double-blind study was carried out in 58 adult patients scheduled for outpatient foot or ankle surgery. They were randomized to receive popliteal block with 40 ml of either 0.5% ropivacaine (group R) or 1% mepivacaine (group M). An atraumatic, Teflon-coated needle connected to a neurostimulator was used to make a single puncture using a posterior approach. The times to onset of sensory and motor block, and the need for intraoperative sedation were recorded. Before discharge, patients were asked to document the time to first analgesic use, time to return of full sensation in the foot, and their evaluation of the technique. RESULTS: Onset time (mean+/-standard deviation, 95% confidence interval) of both sensory block (6.5+/-5.1 min, 4.47-8.49, in group R and 6.2+/-3.7 min, 4.83-7.69, in group M) and motor block (6.6+/-4.4 min, 4.81-8.23, in group R and 7.9+/-4.1 min, 6.29-9.53, in group M) was similar in both groups. Postoperative analgesia lasted longer in group R (15.2+/-5.1 h, 13.25-17.21) than in group M (5.7+/-1.8 h, 5.01-6.41; P<0.001). Duration of sensory block was longer in group R (20.7+/-6.2 h, 18.51-23.01) than in group M (6.5+/-1.7 h, 5.86-7.16; P<0.001). Acceptance of the anesthetic procedure was similar in both groups. CONCLUSION: In this study we demonstrated that both 0.5% ropivacaine and 1% mepivacaine for popliteal block produced rapid, effective and safe anesthesia but postoperative analgesia was more long-lasting with ropivacaine.

[Treatment of fibromyalgic syndrome with feedback]. / Tratamiento del síndrome fibromiálgico con biofeedback.

Fibromyalgic syndrome is one of the most frequent chronic pain disorders in everyday clinical practice. At present, its treatment is restricted by lack of knowledge about its aetiology. This paper describes training in Biofeedback Electromyography as a possible treatment based on the alterations of muscular activities shown by these patients. A review is made of the empirical evidence of its use so far in relation to this syndrome.

[High-frequency jet ventilation with the HFV 970 prototype in laryngeal microsurgery: comparison of 2 injection systems]. / Ventilación con jet a alta frecuencia con el prototipo HFV 970 en microcirugía laríngea: comparación entre dos sistemas de inyección.

OBJECTIVE: To describe the results obtained with the use of a high frequency jet ventilation system with the HFV 970 prototype through two types of injector, an intratracheal cannula and an endotracheal tube, in 12 patients undergoing laryngoscopic microsurgery. PATIENTS AND METHOD: After anesthetic induction with propofol and succinylcholine, an intratracheal cannula was placed in the patients in group A by way of cricothyroid membrane puncture. The tracheas of group B patients were intubated with a number 7 tube, through which was inserted the same type of cannula as had been used with group A patients. A prototype Servo HFV 970 respirator was used with the following protocol: minute volume 120 ml/min, inspiratory time 30%, respiratory rate 120 cycles/min and a FiO2 of 1. Anesthesia was maintained with propofol in continuous perfusion. The parameters studied were peak airway pressure, PCO2, PO2 and pH. Data were recorded at baseline and every 5 min thereafter until the end of surgery. RESULTS: During high frequency jet ventilation there were no statistically significant differences between groups A and B with respect to peak airway pressure. PCO2 in group A increased significantly during surgery, while in group B it decreased significantly. Oxygenation was excellent in both groups, being significantly higher than baseline values at all times studied, with no statistically significant differences between the 2 groups. CONCLUSION: Our results for the efficacy of ventilation and oxygenation with the prototype HFV 970 are similar to those published for conventional high frequency jet ventilation. Using a tracheal tube assures adequate ventilation, but supposes a tendency to entrapment, whereas use of an intratracheal cannula is associated with lower ventilatory efficacy and less entrapment. Oxygenation is excellent with both systems.