Volumetric assessment of the sella turcica: a re-evaluation.

BACKGROUND: The sella turcica volume is widely measured by the Di Chiro-Nelson method. The purpose is to compare the fidelity of a proposed volumetry method vs. the Di Chiro-Nelson method, using computed tomography (CT) images. MATERIALS AND METHODS: Morphometric examination of 173 CT scans were included, of which 52.6% were female. The mean age was 53.2 ± 17.6 years. Considering the Di Chiro-Nelson method, two measurements were added for each axis in the CT evaluation: length (central, left, and right), width (central, anterior, and posterior), and height (central, left, and right). RESULTS: The mean measurements were length: central 10.11 ± 1.44, left 7.45 ± 1.67, right 7.53 ± 1.59; width: central 12.27 ± 2.11, anterior 10.99 ± 1.92, posterior 10.10 ± 1.74; height: central 7.68 ± 1.38, left 7.16 ± 1.35, right 7.40 ± 1.41. A statistically significant difference between sexes was found only in the anterior width (p = 0.01). Using the proposed method, the volume was 342.2 ± 88.5 and 378. 6 ± 113.9 mm³, respectively for females and males (p = 0.02) vs. 476.1 ± 132.4 and 523.8 ± 186.0 mm3 (p = 0.05) using the Di Chiro-Nelson's method. CONCLUSIONS: Women had significantly smaller sella turcica volume than men. This proposed method considers the sella turcica as a not strictly symmetrical structure and indicates reduced variation between the maximum and minimum values, compared to the Di Chiro-Nelson's. Our findings may be useful for reassessment the volume of the sella turcica as the measurements indicate a higher precision.

Sublingual tacrolimus administration provides similar drug exposure to per-oral route employing lower doses in liver transplantation: a pilot study.

BACKGROUND: Per-oral tacrolimus administration is not always practicable. Sublingual administration is a potential alternative, but its feasibility and effectiveness compared with oral route has not been established. AIM: To compare tacrolimus drug exposure after sublingual and oral administration in liver transplant recipients. METHODS: Experimental, open-label, non-randomised, cross-over study. Tacrolimus exposure was evaluated in 32 liver transplant recipients receiving oral administration. 12 h tacrolimus area-under-the-curve (AUC0-12 h ) was calculated using tacrolimus blood concentrations at 0-0.5-1-2-4-6-8-12 hrs post-dose. Recipients were switched to sublingual administration, and dose was adjusted to reach similar trough levels, new AUC0-12 h was calculated. Correlation between AUC0-12 h and trough levels was determined for both oral and sublingual phases. RESULTS: Similar trough levels were accomplished with oral and sublingual administration (6.68 ± 2 ng/mL vs. 6.62 ± 1.9 ng/mL (P = 0.8)). Although concentration 2 h post dose was higher in oral phase (15.36 ± 7.14 vs. 13.18 ± 5.64, P = 0.015), AUC0-12 h was similar in both phases (116.6 ± 34.6 vs. 111.5 ± 36.93 ng/mL* h, P = 0.19). Daily dose of tacrolimus required in sublingual phase was 37% lower than that used in oral phase (P < 0.0001), suggesting significantly increased bioavailability of tacrolimus when employing sublingual route. Good correlation between AUC0-12 h and trough levels was observed in sublingual phase (r2 = 0.74). Twenty-two recipients were maintained on sublingual administration after the end of study (mean follow-up: 18.7 ± 5.8 months). No difference in liver function tests or rejection rates was found during follow-up period. CONCLUSIONS: Sublingual administration of tacrolimus is feasible and provides similar drug exposure compared with oral administration. In our study, at long-term follow-up, sublingual administration was not associated with liver transplant rejection.

[Total gastrectomy in newborn infant]. / Gastrectomía total en lactante.

Total gastrectomy is rarely indicated in childhood and when necessary it involves multiple ulterior therapeutic problems, mainly nutritional, which need a meticulous physiological approach to avoid further complications, as illustrated by the following patient who, at age 15 months, was submitted to total gastric resection, Y en Roux esophagojejunal anastomosis and splenectomy, because of peritonitis secondary to dehiscence of a recent esophagogastric anastomosis for partial gastric resection due to gastric volvulus and necrosis, which in turn were associated to diaphragmatic relaxation. The patient was admitted to our hospital one month later with signs of acute calorie-protein malnutrition (W/A 60% and W/H 68%, NCHS standards) requiring combined parenteral and enteral nutritional support (via central venous catheter and jejunostomy tube for 15 and 35 days respectively) together with intramuscular vitamin B 12, oral iron and oral vitamin supplements before it became possible to fed him only by mouth. Prophylaxis against Streptococcus pneumonia infections with monthly benzatin penicillin was also instituted. Mean daily weight increases of 16 g, W/A 68% and W/H 74% were thus achieved before hospital discharge, without evidence of dumping syndrome nor alkaline reflux.

[Modular diet and parenteral support in persistent diarrhea]. / Dieta modular y apoyo parenteral en diarrea persistente.

Eleven infants with protracted diarrhea were treated with modular diet and short-term parenteral nutrition. Mean age at admission was 3.7 months with males predominating. Enteropathogenic E. coli, classic serotypes, were isolated from 7 patients and rotavirus from one. A child with combined, severe immunodeficiency died. Milk protein intolerance was diagnosed in another patient. Balance studies and peroral biopsies were performed. Malnutrition was more frequent and hospital stay was longer in those infants who developed nosocomial infections. Even though this treatment shortened the duration of the hospitalization, the negative nutritional impact persisted: Weight/Age (NCHS) decreased from 84% to 61%, with rapid recovery after discharge. Fecal lactic acid excretion was increased on admission to 1,296 mg x day and disaccharidase activity was decreased. The modular diet decreased both fecal volume and lactic acid excretion.

[Rotavirus in the feces of children with acute diarrhea in Cochabamba, Bolivia]. / Rotavirus en las deposiciones de niños con diarrea aguda en Cochabamba, Bolivia.

Eighty patients with acute diarrheal disease from Cochabamba, Bolivia, were investigated for rotavirus infection by rotapheresis. Rotavirus ARN was detected in 18 (22.5%) of the cases, thus suggesting that this agent is also a frequent cause of acute diarrhea in the studied population as reported from other places of the world.

Diarrea refractaria. / Protracted diarrhea

Se presentan 15 casos de diarrea refractaria, que requirieron tratamiento con Dieta Modular (D.M.), en la Unidad de Lactantes B del Servicio de Pediatria del Hospital Paula Jaraquemada entre los anos 1981 y 1984. Dos pacientes habian sido enviados de otros hospitales. Los pacientes recibieron D.M. oral con introduccion precoz de fructosa y trigliceridos de cadena mediana. Todos los casos evolucionaron favorablemente, observandose en una paciente una recaida debida a infeccion por Salmonella typhimurium

Dieta modular. / Modular diet

Sobre la base de la experiencia de los autores en el manejo de 15 lactantes menores con diarrea refractaria tratados con Dieta Modular en el Servicio de Pediatria del Hospital Paula Jaraquemada, se efectua una reactualizacion del tema, considerando algunos aspectos de su composicion, utilizacion, posibles inconvenientes y riesgos de complicaciones. Se concluye que es un procedimientos de alimentacion, que manejado de acuerdo a ciertas normas, puede ser de gran utilidad en el tratamiento de la diarrea refractaria

Concentraciones sericas de fenobarbital y metabolismo de calcio y fosforo en el nino. / Serum concentrations of phenobarbital and metabolism of calcium and phosphorus in children

Se comparan 48 ninos con sindrome convulsivo en tratamiento con fenobarbital y 29 controles sanos. Pudo demostrarse que los pacientes con niveles mas altos de fenobarbital plasmatico presentaron las mayores alteraciones bioquimicas del metabolismo fosfocalcico, hecho especialmente notorio en el aumento de la actividad de las fosfatasas alcalinas. Se ha recomendado suplementar con vitamina D a dichos pacientes

Neumotorax en el recien nacido. / Pneumothorax in the newborn infant

El neumotorax y el neumomediastino deben tenerse presente en la etiologia del SDR del recien nacido. Se ha insistido en que la introduccion de procedimientos de ventilacion asistida ha aumentado su riesgo e incidencia. Se analizan 12 casos clinicos de neumotorax sintomatico pesquisados en el Servicio de Neonatologia del Hospital Paula Jaraquemada en el lapso de 2 anos.En el analisis destaca la falta de antecedentes predisponentes definidos. En 7 casos se efectuo toracotomia minima. Se observo una sobrevida a la semana de vida de 8 casos (66%). Se comenta el manejo actual del neumotorax, a fin de mejorar sus expectativas de vida