Synthesis and reactivity of hydroindole enelactams leading to densely functionalized scaffolds.

The 5-endo-trig radical cyclization of N-benzyl-N-[(2-substituted)cycloalkenyl] trichloroacetamides (tetrasubstituted enamides) using Bu3SnH and AIBN is a reliable synthetic procedure giving access to 3a-methyl- and 3a-methoxycarbonyl enelactams. The substrate-controlled diastereoselective enolate alkylation of these enelactams resulted in the synthesis of a set of 3-substituted derivatives that upon reduction furnished polyfunctionalized cis-octahydroindoles. The latter building blocks, which embody three consecutive stereocenters at C-3, C-3a, and C-7a, were also synthesized through an initial reductive radical cyclization using (carbo-substituted)dichloroacetamides.

Iatrogenic femoral neck fracture during closed nailing of the femoral shaft fracture.

BACKGROUND: Intramedullary nails have become a popular implant in the management of femoral shaft fractures. The occurrence of a femoral neck fracture after closed intramedullary nailing is an exceptional complication of this technique that has been rarely reported in the literature. METHODS: We report a retrospective study to identify the possible causes that could produce a fracture of the femoral neck after nailing of the ipsilateral femur. RESULTS: A total of four neck fractures were identified in a series of 494 femoral shaft nailing, all of them not visible on the initial plain films. In two cases, the nail entry point was located lateral to the tip of the greater trochanter. In the other two cases, the entry point was located too medial to the greater trochanter, violating the superoexternal cortex of the femoral neck. CONCLUSION: The event of a femoral neck fracture during closed intramedullary nailing is an unusual complication that may be caused due to a technical mistake related to the location of the nail entry portal in the proximal femur.

[Developmental outcome of extremely low birth weight infants (<1,000 g) during the first three years of life]. / Seguimiento de recién nacidos de peso menor o igual a 1.000 g durante los tres primeros años de vida.

INTRODUCTION: Obstetrics and Perinatal Care has improved in the last few years. As a result there has been a significant increase in preterm babies and longer survival. The risk of abnormalities in their development is high; they need follow up, prompt action and prevention from the neonatal period. MATERIAL AND METHODS: We evaluated 116 preterm babies, birth weight less than or equal to 1,000 grams, admitted to our Unit over 5 years. Seventy five neonates survived after the neonatal period (64.7 %). We studied the development during the first three years of life. RESULTS: The number of admissions of extremely low birth weigh infants has increased by 100 % in the last five years and the survival has increased by 15 %. Failure to thrive was the most frequent problem; in the first 2 years of life neonatal growth retardation was present in more than 50 % of cases (58 % 1st year, 57 % 2nd year, 40 % 3rd year). Catch-up growth occurred except in infants who had intrauterine growth retardation. Motor function disorders were the most serious; minor alterations in this system were the most frequent but usually did not compromise the life of the patient. Cerebral palsy was present in 14 % in the 1st year of life, 17,4 % 2nd year and 19 % 3rd year. Retinopathy of prematurity was very high in our group (74 %), but ophthalmic sequela were infrequent (3.2 % 1st year, 3.9 % 2nd year, and 3.4 % 3rd year); similarly with hearing function (deafness 2.0 %). Only some mild or moderate language development delay was present and psychomotor development was normal in the majority of cases and those who were retarded improved with time. CONCLUSIONS: Nowadays there is a significant increase in the incidence and survival of extremely low birth weigh infants. They have a higher risk of abnormal development. The most frequent problem is failure to thrive and the most serious is cerebral palsy. Major ophthalmic and hearing sequela are rare. Psychomotor and language development is normal in the majority of these patients.

Seguimiento de recién nacidos de peso menor o igual a 1.000 g durante los tres primeros años de vida / Developmental outcome of extremely low birth weight infants (<1.000 g) during the first three years of life

Introducción: Debido a los avances en obstetricia y neonatología nos encontramos actualmente con un aumento importante de recién nacidos prematuros y una mayor supervivencia de éstos. Son niños con mayor riesgo de alteraciones en su desarrollo, por lo que es necesario un seguimiento y una actuación precoces, además de una prevención desde el período neonatal. Material y métodos. Se evalúan 116 prematuros de peso menor o igual a 1.000 g que ingresaron en nuestra unidad durante 5 años. Sobrevivieron al período neonatal 75 (64,7 %) y se hizo un seguimiento de su desarrollo durante los primeros 3 años de vida. Resultados: En esos 5 años aumentó el 100 % el número de ingresos de recién nacidos de bajo peso extremado y la supervivencia subió el 15 %. La secuela más frecuente fue el retraso ponderal; más de la mitad no seguían una curva normal en sus primeros 2 años de vida (el 58 % el primer año, el 57 % el segundo año y el 40 % el tercer año) aunque tendían progresivamente a la normalidad, salvo aquéllos nacidos con retraso del crecimiento intrauterino, que tuvieron peor pronóstico. En cuanto al desarrollo neurológico, las secuelas motoras fueron las más graves; lo más frecuente fueron mínimas alteraciones en la motricidad que no comprometían la vida normal del niño, pero el 14 % presentaba signos de parálisis cerebral el primer año de vida, el 17,4 % el segundo año y el 19 % el tercer año. Aunque el porcentaje de retinopatía de la prematuridad en nuestro grupo fue alto (74 %), las secuelas oftalmológicas fueron escasas (el 3,2 % el primer año, el 3,9 el segundo año y el 2,4 % el tercer año), así como las auditivas (sordera, 2,0 %). El desarrollo del lenguaje y el psicomotor fue normal en la mayoría de los niños y los que presentaron algún retraso fue leve o moderado. Conclusiones: Nos encontramos ante un aumento importante de la incidencia y supervivencia de recién nacidos de bajo peso extremo, con mayor riesgo de presentar secuelas en su desarrollo. La más frecuente es el retraso en la curva ponderal y la más grave, la parálisis cerebral; las alteraciones oftalmológicas y auditivas graves son poco frecuentes y el desarrollo psicomotor y del lenguaje es normal en la mayoría de estos niños (AU)

Introduction: Obstetrics and Perinatal Care has improved in the last few years. As a result there has been a significant increase in preterm babies and longer survival. The risk of abnormalities in their development is high; they need follow up, prompt action and prevention from the neonatal period. Material and methods: We evaluated 116 preterm babies, birth weight less than or equal to 1,000 grams, admitted to our Unit over 5 years. Seventy five neonates survived after the neonatal period (64.7 %). We studied the development during the first three years of life. Results: The number of admissions of extremely low birth weigh infants has increased by 100 % in the last five years and the survival has increased by 15 %. Failure to thrive was the most frequent problem; in the first 2 years of life neonatal growth retardation was present in more than 50 % of cases (58 % 1st year, 57 % 2nd year, 40 % 3rd year). Catch-up growth occurred except in infants who had intrauterine growth retardation. Motor function disorders were the most serious; minor alterations in this system were the most frequent but usually did not compromise the life of the patient. Cerebral palsy was present in 14 % in the 1st year of life, 17,4 % 2nd year and 19 % 3rd year. Retinopathy of prematurity was very high in our group (74 %), but ophthalmic sequela were infrequent (3.2 % 1st year, 3.9 % 2nd year, and 3.4 % 3rd year); similarly with hearing function (deafness 2.0 %). Only some mild or moderate language development delay was present and psychomotor development was normal in the majority of cases and those who were retarded improved with time. Conclusions: Nowadays there is a significant increase in the incidence and survival of extremely low birth weigh infants. They have a higher risk of abnormal development. The most frequent problem is failure to thrive and the most serious is cerebral palsy. Major ophthalmic and hearing sequela are rare. Psychomotor and language development is normal in the majority of these patients (AU)