Functional outcome after cord detethering in fecally incontinent patients with anorectal malformations.

PURPOSE: Tethered cord (TC) occurs in 36% of patients with anorectal malformations (ARMs), for whom the benefit of detethering surgery remains unclear regarding bowel and/or bladder function. This study aimed to examine whether cord detethering could improve fecal and urinary incontinence in these patients. METHODS: This was a retrospective study of TC patients (>3 years old) with fecal incontinence and ARMs, who underwent detethering surgery between 2016 and 2020 and were followed up for at least 6 months. RESULTS: Of the 27 included patients, 55% had sacral ratios between 0.4 and 0.7, and in 37% it was < 0.4; the remaining 8% was over 0.7; 52% suffered from colonic hypermotility. After detethering surgery, partial fecal continence was achieved in five patients (18%); total fecal continence, in ten patients (37%); 12 (44%) remained fecally incontinent. Partial urinary continence was obtained in four cases (14%), and the number of patients with total urinary continence rose from 7 (25%) to 15 (55%). Lower extremity symptoms were also improved in 72% of the cases. Patients with colonic hypomotility were found to have a better functional outcome than those with colonic hypermotility (69% vs. 43%, respectively). CONCLUSION: Our study demonstrated that detethering surgery led to remarkably improved bowel and bladder control in ARM patients with fecal incontinence, which, surprisingly, was not associated with sacral ratio.

Jejunojejunal intussusception in foal: case report / Intussuscepção jejunojejunal em potro: relato de caso

Intussusceptions are unusual intestinal incidents which may result in acute and progressive or recurrent abdominal discomfort in foals. This condition asymptomatically affects newborn foals (3-12 months), are surgical emergencies when it involves the small intestine, especially the jejunum. Transabdominal ultrasound evaluation is an important diagnostic method, due to their size limitations for acute abdomen evaluation. The present report shows the importance of using transabdominal ultrasound in foals with acute abdomen.(AU)

As intussuscepções são acidentes intestinais incomuns e que podem resultar em desconforto abdominal agudo e progressivo ou recorrente em potros. Esta condição afeta potros neonatos de forma assintomática e de 3 a 12 meses são emergências cirúrgicas quando envolvem o intestino delgado, principalmente o jejuno. A avaliação ultrassonográfica transabdominal é um importante para o exame desses animais devido às limitações de seu tamanho para avaliações do abdômen agudo. O presente relato de caso mostra a importância da utilização do ultrassom transabdominal em potros com abdômen agudo.(AU)

Neutropenia febril em pacientes pediátricos com câncer / Febrile neutropenia in pediatric patients with cancer

A neutropenia febril é uma complicação que acomete frequentemente pacientes com câncer que estejam recebendo quimioterapia. É considerada situação potencialmente fatal, sendo classificada como emergência médica. Todo o paciente com neutropenia que apresente febre deve ser investigado e receber tratamento empírico com antimicrobiano de amplo espectro, tão logo seja feito o diagnóstico. Essa medida é fundamental nestes pacientes que apresentam baixa resposta imune pois reduz drasticamente sua mortalidade.

Febrile neutropenia is a potentially fatal condition often found in cancer patients undergoing chemotherapy, being the first cause of hospitalization in these cases and therefore is considered a medical emergency. Neutropenia should be investigated in all patients undergoing chemotherapy who present with fever. Due to the low immune response of these patients to infectious agents, the administration of empiric broad-spectrum antibiotics is mandatory and drastically reduces mortality.

Primeiro atendimento do recém-nascido na sala de parto / First care of the newborn in the delivery room

Esse artigo é uma revisão bibliográfica sobre o primeiro atendimento do recém-nascido e o primeiro exame físico realizado na sala de parto. Aborda também a importância do primeiro contato do bebê e de sua mãe e da presença do pai na hora do parto. Tem o objetivo de revisar o primeiro atendimento ao recém-nascido que é fundamental na redução de óbitos e sequelas neurológicas.

This article is a literature review on the first care of the newborn and the first physical examination in the delivery room. It also discusses the importance of the first contact of the baby and his mother and father's presence during childbirth. It aims to review the first care of the newborn that is critical in reducing deaths and neurological sequel.

Venezuelan kindreds reveal that genetic and environmental factors modulate Huntington's disease age of onset.

Huntington's disease (HD) is an autosomal dominant neurodegenerative disease caused by a triplet (CAG) expansion mutation. The length of the triplet repeat is the most important factor in determining age of onset of HD, although substantial variability remains after controlling for repeat length. The Venezuelan HD kindreds encompass 18,149 individuals spanning 10 generations, 15,409 of whom are living. Of the 4,384 immortalized lymphocyte lines collected, 3,989 DNAs were genotyped for their HD alleles, representing a subset of the population at greatest genetic risk. There are 938 heterozygotes, 80 people with variably penetrant alleles, and 18 homozygotes. Analysis of the 83 kindreds that comprise the Venezuelan HD kindreds demonstrates that residual variability in age of onset has both genetic and environmental components. We created a residual age of onset phenotype from a regression analysis of the log of age of onset on repeat length. Familial correlations (correlation +/- SE) were estimated for sibling (0.40 +/- 0.09), parent-offspring (0.10 +/- 0.11), avuncular (0.07 +/- 0.11), and cousin (0.15 +/- 0.10) pairs, suggesting a familial origin for the residual variance in onset. By using a variance-components approach with all available familial relationships, the additive genetic heritability of this residual age of onset trait is 38%. A model, including shared sibling environmental effects, estimated the components of additive genetic (0.37), shared environment (0.22), and nonshared environment (0.41) variances, confirming that approximately 40% of the variance remaining in onset age is attributable to genes other than the HD gene and 60% is environmental.

Aneurisma de aorta abdominal roto y contenido a cavidad peritoneal / Rupture abdominal aortic aneurysm restrained in peritoneal cavity

El aneurisma de aorta abdominal roto se asocia con un alto índice de mortalidad reportándose entre 15 por ciento hasta 80 por ciento de los casos. Presentamos el caso de una paciente de 80 años de edad con un aneurisma de aorta abdominal roto y contenido a la cavidad peritoneal presentando tres síntomas relevantes a su ingreso a urgencias: tumoración abdominal pulsátil, dolor abdominal súbito e hipotensión, caracterizada por lipotimia y diaforesis profusa, se documenta con radiografía y tomografía computarizada de abdomen, ya que permaneció hemodinámicamente estable en urgencias. El curso postoperatorio fue satisfactorio. Conclusiones: El síndrome de abdomen agudo tiene como diagnóstico diferencial el aneurisma de aorta abdominal roto y por lo tanto, el cirujano general en las unidades de urgencias debe tener el suficiente criterio para poder diferenciar las modalidades clínicas de cómo se presenta esta patología en especial.

Tres años de experiencia en el manejo de la enfermedad aorto-iliaca en el Centro Médico Nacional 20 de Noviembre / Three year experience in the management of aorto-iliac disease at Centro Médico Nacional 20 de Noviembre

Se evaluaron los resultados obtenidos en el manejo quirúrgico de los pacientes con enfermedad aorto-iliaca obstructiva tratados en el CMN 20 de Noviembre ISSSTE. De junio de 1995 a junio de 1998 se operaron 20 pacientes; quince masculinos (75 por ciento) y cinco femeninos (25 por ciento), con una variación de edad de 48-74 años (media 66.3 años). Factores de riesgo: tabaquismo 90 por ciento, diabetes mellitus 65 por ciento, hipertensión arterial 40 por ciento, cardiopatía isquémica 20 por ciento. Indicaciones de cirugía-isquemia crítica 14 pacientes (70 por ciento) y claudicación intermitente incapacitante 6 pacientes (30 por ciento). A todos los pacientes se les realizó derivación aorto-bifemoral. Cinco pacientes (20 por ciento) con enfermedad aorto-iliaca tipo III requirieron derivación secuencial distal, 3 a la arteria poplítea por debajo de la rodilla y dos a la tibial anterior. El tiempo quirúrgico promedio fue de 4.15 horas con pinzamiento aórtico promedio de 42.7 min. En el grupo de pacientes con isquemia crítica la mortalidad operatoria fue de 21 por ciento (3 pacientes) por infarto agudo al miocardio (AIM) en un paciente, coagulopatía en otro, e insuficiencia renal aguda e infarto agudo al miocardio en el tercero. A los pacientes a quienes se realizó derivación distal ninguno falleció y los injertos continúan permeables. En el grupo de pacientes operados por claudicación intermitente incapacitante se presentó mortalidad en un paciente (16 por ciento), ocasionado por infarto agudo al miocardio. Durante el seguimiento de 2-38 meses (22.2 meses), fallecieron 2 pacientes uno por cáncer (Ca) broncopulmonar y otro por neuroinfección. En los 14 pacientes vivos sus prótesis permanecen clínicamente y por Doppler permeables.

Complicaciones abdominales en cirugía cardiaca / Abdominal complications in cardiac surgery

Las complicaciones intra-abdominales en cirugía cardiaca son poco frecuentes (0.41-2 por ciento) pero se asocian a una elevada mortalidad (25-66 por ciento). En un periodo de seis años en el Hospital American British Cowdray en la ciudad de México, se operaron del corazón 228 pacientes, de los cuales cuatro (1.75 por ciento) desarrollaron cinco complicaciones intra-abdominales: dos colecistitis alitiásica aguda, uno sangrado del tubo digestivo alto, uno perforación intestinal por úlcera isquémica, y uno hematoma de la pared abdominal. Tres pacientes requirieron cirugía. El diagnóstico de síndrome abdominal agudo en pacientes posoperados de cirugía cardiaca ofrece gran dificultad, pero su pronto reconocimiento y tratamiento médico o quirúrgico, contribuyen a disminuir su alta morbilidad y mortalidad

Estenosis de sigmoides por talcosis / Sigmoid colon stenosis due to talcosis

La reacción inflamatoria en la cavidad abdominal como consecuencia de la contaminación por diferentes polvos empleados para lubricar los guantes quirúrgicos es una complicación postoperatoria poco frecuente y de difícil diagnóstico. Presentamos un caso de estenosis del sigmoides por talcosis en un niño de 14 años de edad