ABSTRACT
Introducción: El síndrome de Down (SD) es la anormalidad cromosómica más frecuente; hasta dos tercios de los niños con SD presenta una posible pérdida auditiva que puede comprometer el desarrollo del lenguaje. El objetivo de esta revisión es describir la prevalencia de la pérdida auditiva en niños con SD, los factores de riesgo y su relación con el desarrollo del lenguaje. Metodología: Revisión sistemática de la literatura. Se identificaron 69 artículos a través de las bases de datos PubMed, Science Direct y Scopus. En función de los criterios de inclusión, se escogieron 35 artículos. Resultados: La prevalencia de pérdida auditiva en niños con SD oscila entre el 34 y el 36%. La alteración de tipo conductivo asociada a otitis media con efusión y un canal auditivo estrecho son los factores de riesgo más frecuentes. La implantación de tubos de timpanostomía demuestra unos índices de curación de la otitis media y una mejoría de la agudeza auditiva significativamente menores que en la población general. Otro tipo de implantes, como el BAHA (bone anchored hearing aids) y el coclear, muestran beneficios sobre la calidad de vida y el desempeño físico y social; sin embargo, los estudios realizados al respecto adolecen de una muestra limitada que no permite sacar conclusiones. Finalmente, no existe evidencia de una relación directa entre la pérdida auditiva y el desarrollo del lenguaje en niños con SD. Conclusiones: Se debe realizar un cribado auditivo en el periodo neonatal y un seguimiento con un diagnóstico adecuado de las in-fecciones del oído durante toda la infancia en los niños con SD, lo que permitiría establecer un tratamiento apropiado y disminuir las posibles alteraciones del lenguaje (AU)
Introduction: Down syndrome (DS) is the most frequent chromosomal abnormality; nearly two-thirds of children with DS may develop hearing loss and delayed or abnormal language development. The aim of this review was to describe the frequency of hearing loss in children with DS, its relationship with language development and risk factors for its clinical presentation. Methodology: Systematic review of literature. 69 articles were identified through database searching on PubMed and Scopus. 35 articles met selection and inclusion criteria. Results: The prevalence of hearing loss in children with DS ranges between 34% and 36%. Conductive hearing loss is frequently as-sociated with effusive otitis media, and a narrow auditory canal. The implantation of tympanostomy tubes showed lower success rates in otitis media and improvement of hearing in comparison to healthy children. Other type of hearing aids such as BAHA (bone an-chored hearing aids) and cochlear implants have shown possible benefits in quality of life, physical and social performance. Finally, there is no evidence of a direct relation between hearing loss or other disabilities in language development in these children. Conclusions: Hearing screening should be done in the neonatal period and follow-up with a timely diagnosis of childhood ear infections in children with DS in order to provide accurate and timely interventions (AU)
Subject(s)
Humans , Male , Female , Child , Down Syndrome/complications , Hearing Loss/epidemiology , Language Development , Risk Factors , Quality of Life , Bibliometrics , Otitis Media/complicationsABSTRACT
INTRODUCTION: In 1994 our group began its experience with pediatric liver transplantation. The experience gained during this period is the largest in the country, positioning the Hospital Luis Calvo Mackenna and Clinica Las Condes as major referral centers in the public and private sectors. The aim of this study was to report our experience of our pediatric liver transplantation program during this period. METHODS: The liver transplantation database of Hospital Luis Calvo Mackenna and Clinica Las Condes between January 1994 and July 2011 was reviewed recording age, gender, indications for transplantation, surgical technique, complications, and survival. Survival rates were calculated using Kaplan-Meier analysis. RESULTS: During the period described 230 transplantations were performed in 189 pediatric patients. Fifty-five percent were male patients. The average age was 5 years. The main causes of transplantation were biliary atresia (50%), fulminant hepatic failure (25%), and other cholestatic diseases by 10%. Vascular and biliary complications were the leading cause of graft loss and retransplantation. The overall rate of retransplantation at 5 years was 20%. The technique of living donor was used in 28% of the cases. The 1-year patient actuarial survival rate was 80%, 73% at 5 years, and 68% at 10 years. In the last 3 years the survival rate at 1 year exceeds 90%. DISCUSSION: Our program includes more than 90% of the national liver experience. The incorporation of living donor is a milestone that has enabled us to save many patients who previously died while waiting for an organ. Its use in cases of full acute liver failure has allowed us to dramatically reduce mortality on the waiting list. Our results in the last 3 years reflect the experience that results in a significant decrease in mortality, comparing favorably to other series published in the international literature.
Subject(s)
Liver Transplantation , Age Factors , Child, Preschool , Chile , Female , Graft Survival , Humans , Kaplan-Meier Estimate , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Living Donors/supply & distribution , Male , Postoperative Complications/mortality , Postoperative Complications/surgery , Program Evaluation , Reoperation , Risk Factors , Survival Rate , Time Factors , Treatment Outcome , Waiting ListsABSTRACT
INTRODUCTION: Pediatric liver transplantation is limited by donation. In the last 5 years, urgent conditions have forced transplant teams to accept donors with minor suboptimal conditions, termed "extended donor criteria." Among those, the risk of using severe hypernatremic donors (SHD) for liver transplant is not yet well established. The aim of this study is to report the outcome of pediatric patients receiving grafts from SHD. METHODS: Clinical records of patients transplanted in the last 3 years at Hospital Luis Calvo Mackenna, Santiago, Chile, were reviewed. Outcome was evaluated in terms of patient and graft survival and complications potentially associated to the donor condition. RESULTS: Five of 33 deceased donor transplants presented with SHD. All recipients were waiting transplant in an acute condition, one of them in acute liver failure (ALF). No living related donor was available. Donors' serum sodium was 169 to 193 mEq/L before medical management and between 157 and 172 mEq/L at procurement. One patient died from sepsis related to biliary complications, and the patient suffering ALF developed primary graft nonfunction, received a second transplant 2 weeks later, and recovered to stable medical condition. No other complication was registered in these patients. DISCUSSION: Our findings allow us to postulate that hypernatremic deceased donors may be used for pediatric liver transplant under special circumstances.
Subject(s)
Donor Selection , Hypernatremia/complications , Liver Transplantation , Tissue Donors/supply & distribution , Age Factors , Biomarkers/blood , Cadaver , Child , Chile , Female , Humans , Hypernatremia/blood , Hypernatremia/diagnosis , Hypernatremia/mortality , Infant , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Male , Postoperative Complications/mortality , Postoperative Complications/surgery , Reoperation , Risk Factors , Severity of Illness Index , Sodium/blood , Time Factors , Treatment Outcome , Waiting ListsABSTRACT
En la era de la cirugía mínimamente invasiva el manejo de la coledocolitiasis asociada a colelitiasis es aún motivo de controversia. Presentamos a continuación los resultados de un protocolo de manejo de estos pacientes de acuerdo al riesgo estimado de presentar coledocolitiasis asociada a colelitiasis. Se incluyeron en el estudio 605 pacientes candidatos a colecistectomía laparoscópica (CL). De acuerdo a criterios clínicos, bioquímicos y radiológicos se dividió a los pacientes en tres grupos de acuerdo al riesgo de presentar coledocolitiasis. A los pacientes con diagnóstico ecográfico de coledocolitiasis y a aquellos ictéricos al ingreso, se les practicó una CPRE previa a la CL. A aquellos sin sospecha para coledocolitiasis se les estudió mediante colangiografía endovenosa e intraoperatoria. Se analizan los resultados obtenidos en el tratamiento de la coledocolitiasis asociada a colelitiasis mediante la combinación CPRE + CL versus colecistectomía clásica y coledocostomía. Se concluye que el uso juicioso de los criterios para estimar el riesgo de coledocolitiasis ayuda en el uso selectivo de la CPRE y que está combinada con la CL representa una buena alternativa para el tratamiento clásico
Subject(s)
Humans , Gallstones/diagnosis , Gallstones/surgery , Cholelithiasis/diagnosis , Cholelithiasis/surgery , Gallstones/complications , Minimally Invasive Surgical Procedures , Cholangiopancreatography, Endoscopic Retrograde/methodsABSTRACT
La colecistectomia laparoscópica es hoy el tratamiento de elección en el tratamiento quirúrgico de la colelitiasis. Esta patología es poco frecuente en niños. De un total de 1205 pacientes operados en el período mayo de 1994 hasta mayo 1996, 10 eran menores de 15 años. Edad promedio de 9,9 años; 4 de sexo masculino y 6 de sexo femenino. El motivo de consulta fue dolor abdominal en todos los casos, 2 pacientes se presentaron como colecistitis aguda y se intervinieron de urgencia, el resto en forma electiva. Todos se operaron usando técnica francesa. Se realizó colangiografía intraoperatoria en 2 pacientes. Su evolución postoperatoria fue satisfactoria en todos los casos. No hubo complicaciones. El alta fue a los 1,9 dias en promedio y se reintegraron a sus actividades normales precozmente luego del alta
