Late complications of percutaneous tracheostomy using the balloon dilation technique. / Complicaciones tardías de la traqueotomía percutánea con la modalidad de dilatación con balón.

OBJECTIVE: The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. DESIGN: A prospective, observational cohort study was carried out. SCOPE: Two medical-surgical intensive care units (ICU). PATIENTS: All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. INTERVENTIONS: All patients underwent PT according to the Ciaglia Blue Dolphin® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. VARIABLES: Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. RESULTS: A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time.

Pneumocystis jirovecii pneumonia in developing countries.

Pneumocystis pneumonia (PcP) is a serious fungal infection among immunocompromised patients. In developed countries, the epidemiology and clinical spectrum of PcP have been clearly defined and well documented. However, in most developing countries, relatively little is known about the prevalence of pneumocystosis. Several articles covering African, Asian and American countries were reviewed in the present study. PcP was identified as a frequent opportunistic infection in AIDS patients from different geographic regions. A trend to an increasing rate of PcP was apparent in developing countries from 2002 to 2010.

Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques.

BACKGROUND: Although the standard tracheostomy described in 1909 by Jackson has been extensively used in critical patients, a more simple procedure that can be performed at the bedside is needed. Since 1957 several different types of percutaneous tracheostomy technique have been described. The purpose of the present study was to compare two bedside percutaneous tracheostomy techniques: percutaneous dilatational tracheostomy (PDT) and the guidewire dilating forceps (GWDF). MATERIALS AND METHODS: A prospective study in two medical/surgical intensive care units (ICUs) was carried out. Sixty-three critically ill patients who required endotracheal intubation for longer than 15 days were consecutively selected to undergo PDT (25 patients) or GWDF (38 patients) technique. Intraoperative and postoperative complications were recorded. RESULTS: Age (mean +/- standard error) was 63 +/- 1.1 years. The patients had been mechanically ventilated for an average of 19.8 +/- 1.2 days. The GWDF technique was significantly faster than PDT technique (P = 0.02). Fifteen complications occurred in 10 out of 63 (15%) patients. They were as follows: tracheal tear (one patient in each group; in one case this was due to false passage); transient hypotension (one patient in the PDT group and two patients in the GWDF group); atelectasis (one patient in the PDT group); and haemorrhage (one patient in the PDT group and three patients in the GWDF group). In both patients with tracheal tear, reduced arterial oxygen saturation (SaO2) with concomitant subcutaneous emphysema ensued. CONCLUSION: We found no statistical differences between complications with both techniques. The surgical time required for the GWDF technique was less than that for PDT.

[Opportunistic invasive mycoses in AIDS. An autopsy study of 211 cases.]. / Micosis oportunistas invasivas en el sida. Un estudio de 211 autopsias.

The opportunistic mycoses are an important cause of morbidity-mortality among patients with severe immunosuppression provoked by HIV. We present a study of 211 serial autopsies of patients with HIV/AIDS infection carried out by our service in a period of 10 years, observing frequency of invasive mycoses of the 44.1%. Pneumocystis carinii infection was the most frequent (32%) with a prevalence of lung affection. Candidiasis follows it in order of frequency with 31.1%, predominantly the oropharyngeal manifestation. Systemic or cerebromeningeal cryptococcosis were serious and common disorder (29%). Diseminated histoplasmosis occurred in 9.6% and in three cases (3.2%) pulmonary aspergillosis was diagnosed as a postmortem discovery in cavity lesions. In our series, other less common HIV-associated were not identified.

[Anisakidosis of the colon as a cause of acute abdomen]. / Anisakidosis del colon como causa de abdomen agudo.

We report a case of acute abdomen caused by the invasion of the ascending colon by larvae of Anisakis simplex in a 57 year-old-woman whose initial symptoms were colic abdominal pain, diarrhea and fever. The diagnosis was done by the histological study of the surgical specimen in which two parasites were morphologically identified in the submucosa. Although a causal relationship of the disease with the ingestion of crude fish could not be established initially, there were antecedents of ingestion of anchovy in vinegar (Engraulis encrasicholus) and dyspeptic symptoms for several months.

Osteopromotion for cranioplasty: an experimental study in rats using acidic fibroblast growth factor.

BACKGROUND: Many growth factors influence the bone healing cascade. Furthermore, the occasional failure of bone repair may in part be due to perturbation in the activation of local growth factors. Local activation of fibroblast growth factors (FGFs) at the fracture site may serve to increase neovascularization, and induce early granulation formation that can affect bone healing. METHODS: We have performed a rat parietal (6 x 3 mm) critical size defect (CSD). Human recombinant acidic fibroblast growth factor (hraFGF) imbided in agarose was topically administered at the craniectomy site. Control animals received agarose alone in the same manner. Three weeks after surgery, osteopromotion was histologically evaluated. RESULTS: hraFGF-treated animals show a continuous bridge of regenerated bone extending from one edge of the defect to the other. None of the parietal defects that had been treated with agarose contained new bone in the central portion. CONCLUSION: Our results suggest an important role of FGFs to promote large cranioplasty repair and support the use of these proteins as an alternative choice for bone grafts and bone substitutes.

Evaluation of the antimeningococcal immunoglobin activity against five strains of Neisseria meningitidis group B from Latin America using mice as model.

To know the activity of antimeningococcal immunoglobulin, Balb/c mice of 18-22 g of body weight were challenged with 5 serotype B strains of Neisseria meningitidis (Nm) isolated from patients of different Latin American countries. The specific antimeningococcal Ig was extracted from the serum of volunteers previously vaccinated with the antimeningococcal BC vaccine VA-MENGOC-BC (Finlay Institute, Havana, Cuba). The Ig was intraperitoneally (IP) administered in a unique dose of 10 mg/mouse. The strains A, B, C, CH and D were inoculated IP in the following charges: strain A, 20 LD50; B, 25 LD50; C, 44.5 LD50; CH, 36 LD50, and D, 200, 20 and 2 LD50. For each strain, a control group received living bacteria and virulent stimulating factor (VSF). The Ig was injected 30 min before or 30 min after the challenge dose had been given, except for strain D, which only received the Ig 30 min after the challenge. As VSF, 0.5 mg of iron in the form of iron dextran was used. The experiment was analyzed considering the survival time after the challenge for each strain compared to the corresponding control group (C). When the Ig was used 30 min before the challenge, the protection period for the A strain was (C:18.1h) more than 72h (P<0.001) and 100% survival; for the B strain, (C:29.5h) 42h (P<0.05) and almost 20% survival; for the C strain (C:16.5h) 35h (P<0.01) with a 40% survival, and the CH strain (C:18.1h) 26.5h (P<0.02), with a 20% survival. When the Ig was injected 30 min after the challenge, the average survival time and the survival for the A strain was 28h (P<0.05) with 62.5%; for the B strain it was 42 h (P<0.005) and 0.0%; for the C strain 27.3 h (P<0.05) and 30%; for the CH strain 25.8h (P<0.05) and 0.0%, and for the D strain 19.1h, 26h, and more than 72h with a 0.0%, 60% and 100%, depending on the challenging dose. In general, the specific Ig used showed a protective effect in mice against the different Latin American strains tested. Additionally, the experimental model proved to be useful for the study of the antimeningococcal human Ig.

[Craniofacial dysmorphism in pediatric AIDS. Presentation of a case]. / Dismorfismo cráneo-facial en el SIDA pediátrico. Presentación de un caso.

The case of a five-year-old mulatto girl with craniofacial dysmorphism, infected with AIDS virus, is presented. The girl had ocular hypertelorism; eyes slanted upwards; increase of the distance between the internal and external canthi; prominent triangular philtrum; thick lips; prominent forehead; flat nasal bridge; large parotid glands, which indicate that the infection must have transmitted during fetal life. These features were not observed in children infected with AIDS through other ways such as perinatal transmission, blood transfusions and breastfeeding.

[Report pf the first case of lymphogranuloma venereum (LGV) in an HIV seropositive patient in Cuba]. / Reporte del primer caso de linfogranuloma venéreo (LGV) en un paciente seropositivo para VIH en Cuba.

The most important clinical and epidemiological aspects of the lymphogranuloma venereum as a sexually-transmitted disease are described. We present a summary of the clinical history of an HIV-positive patient who presented with a tumoral lesion in the inguinal region presumptive of lymphogranuloma venereum. The diagnostic value of the polymerase chain reaction (PCR) technique for the establishment of an accurate diagnosis is stressed the epidemiological importance of the report of this sexually-transmitted disease in an HIV-positive patient for the first time in Cuba is also pointed out. A good response was attained with Doxycycline.

[Pediatric AIDS: a report of the first fatal Cuban pediatric case]. / SIDA pediátrico: descripción del primer caso infantil cubano fallecido.

The case of a Cuban child with AIDS acquired by perinatal transmission is reported. Thirteen days after birth, the child had chronic diarrhoeas affecting its pondostatural development. It was hospitalized many times due to recurrent respiratory processes, in one of which Pneumocystis carinii was detected. Oral candidiasis, cryptosporidiosis and intestinal amebiasis in faeces were also diagnosed. It died with generalized tonic-clonic convulsions and bradypnea. At autopsy, the direct death cause was endocranial hypertension due to unspecific sub-acute viral meningitis.

[Approximation to the epidemiology of salt intake and arterial pressure. Study on a community of Toledo]. / Aproximación a la epidemiología de la ingesta de sal y la presión arterial. Estudio de una comunidad de Toledo.

The relationship between salt intake and Blood Pressure (BP) is studied in a random sample of adults from 25 to 64 years of age in a urban community in Toledo, by means of a semiquantitative determination with a reactive (Saltex strip). Of the 3,824 people included in the census (1984), 384 were selected, regarding whom, in addition to the Cl- NaCl in the night fraction of urine being studied, the average BP of two samples, the body mass index (BMI), chronic communicable diseases, the use of tobacco, alcohol and drugs, as well as other social variables of the population were studied. Data was collected regarding the salt intake of 238 individuals and the BP of 236 individuals. A prevalence of high blood pressure (BP greater than 140 and/or 90 mmHg) in 14% was observed, and 81% of the sample studied ingested over 11 g of salt daily. The results were analyzed in strata, by age and BMI to avoid factors resulting in confusion, no relationship between salt intake, BP and rest of the variables studied being found in our community.