Manejo del traumatismo rectal en la edad pediátrica / Management of rectal traumatism in the pediatric age

Objetivo. En pediatría, las heridas anorrectales son infrecuentes y su manejo ha incluido clásicamente la derivación intestinal. Actualmente, y si las condiciones son favorables, se tiende a realizar una reparación primaria de la lesión sin colostomía. Presentamos nuestra casuística y experiencia en el manejo de esta patología, revisando la literatura con el objetivo de crear unas pautas de actuación a seguir en estos casos. Material y métodos. Estudio retrospectivo, descriptivo, de pacientes con herida anorrectal en nuestro centro entre 2005-2011. Se analizan los datos demográficos de cada paciente, mecanismo de la lesión, malformaciones asociadas, tiempo de evolución lesión-cirugía, tratamiento, estancia hospitalaria y evolución. Resultados. Los 7 pacientes revisados se clasifican según el tipo de lesión en dos grupos; lesiones iatrogénicas (todas con malformaciones asociadas) y lesiones accidentales no iatrogénicas. En 4 de ellos se realizó una TC (tomografía computerizada). Ninguno se exploró mediante sigmoidoscopia. En los pacientes revisados, se realizó colostomía de (..) (AU)

Objective. In pediatrics anorectal injuries are not very common and their management classically includes an intestinal derivation. In selected patients and with favourable conditions, there has been an increased interest in repair the injuries without derivation. We presentour experience in the management of this pathology, looking through the literature. The aim of the study is to develop some guidelines to follow in these cases. Patients and methods. Retrospective and descriptive study of patients with anorectal injury admitted in our institution between 2005-2011. Data abstraction included patient demographic data, mechanism of injury, associated injuries, time between injury and treatment, methods of diagnosis, treatment, length of stay and resultant complications. Results. 7 patients were reviewed and classified according to the type of the injury in two groups: iatrogenic injuries (all of them with (..) (AU)

[Management of rectal traumatism in the pediatric age]. / Manejo del traumatismo rectal en la edad pediátrica.

OBJECTIVE: In pediatrics anorectal injuries are not very common and their management classically includes an intestinal derivation. In selected patients and with favourable conditions, there has been an increased interest in repair the injuries without derivation. We present our experience in the management of this pathology, looking through the literature. The aim of the study is to develop some guidelines to follow in these cases. PATIENTS AND METHODS: Retrospective and descriptive study of patients with anorectal injury admitted in our institution between 2005-2011. Data abstraction included patient demographic data, mechanism of injury, associated injuries, time between injury and treatment, methods of diagnosis, treatment, length of stay and resultant complications. RESULTS: 7 patients were reviewed and classified according to the type of the injury in two groups: iatrogenic injuries (all of them with associated malformations) and non-iatrogenic accidental injuries. A CT was performed in 4 cases. None of them was explored with sigmoidoscopy. We performed colostomy without primary repair in four patients, primary injury repair with colostomy in two patients, and one patient underwent primary repair without colostomy. All patients had a long evolution (mean hospital length of stay was 31,4 days) with many dressings and some of them required relaparotomy. Fecal continence and long term results have been, in all of them, satisfactories. CONCLUSIONS: An early and complete diagnosis of anorectal injuries is basic for an appropriate approach to the treatment. Primary repair of injuries without colostomy could be a safe procedure as a first treatment in selected patients: stables, with no contamination and no associated injuries. It is very important to individualize each patient to minimize the morbidity, reduce the hospital length of stay and reach a full continence.

Inspiratory flow-volume curve in snoring patients with and without obstructive sleep apnea.

We analyzed the flow-volume curves of 50 patients with complaints of snoring and daytime sleepiness in treatment at the Pneumology Unit of the University Hospital of Brasília. The total group was divided into snorers without obstructive sleep apnea (OSA) (N = 19) and snorers with OSA (N = 31); the patients with OSA were subdivided into two groups according to the apnea/hypopnea index (AHI): AHI < 20/h (N = 14) and AHI > 20/h (N = 17). The control group (N = 10) consisted of nonsmoking subjects without complaints of snoring, daytime sleepiness or pulmonary diseases. The population studied (control and patients) consisted of males of similar age, height and body mass index (BMI); spirometric data were also similar in the four groups. There was no significative difference in the ratio of forced expiratory and inspiratory flows (FEF50%/FIF50%) in any group: control. 0.89; snorers, 1.11; snorers with OSA (AHI < 20/h), 1.42, and snorers with OSA (AHI > 20/h), 1.64. The FIF at 50% of vital capacity (FIF50%) of snoring patients with or without OSA was lower than the FIF50% of the control group (P < 0.05): snorers 4.30 l/s; snorers with OSA (AHI < 20/h) 3.69 l/s; snorers with OSA (AHI > 20/h) 3.17 l/s and control group 5.48 l/s. The FIF50% of patients with severe OSA (AHI > 20/h) was lower than the FIF50% of snorers without OSA (P < 0.05): 3.17 l/s and 4.30 l/s, respectively. We conclude that 1) the FEF50%/FIF50% ratio is not useful for predicting OSA, and 2) FIF50% is decreased in snoring patients with and without OSA, suggesting that these patients have increased upper airway resistance (UAR).

Inspiratory flow-volume curve in snoring patients with and without obstructive sleep apnea

We analyzed the flow-volume curves of 50 patients with complaints of snoring and daytime sleepiness in treatment at the Pneumology Unit of the University Hospital of Brasília. The total group was divided into snorers without obstructive sleep apnea (OSA) (N = 19) and snorers with OSA (N = 31); the patients with OSA were subdivided into two groups according to the apnea/hypopnea index (AHI): AHI<20/h (N = 14) and AHI>20/h (N = 17). The control group (N = 10) consisted of nonsmoking subjects without complaints of snoring, daytime sleepiness or pulmonary diseases. The population studied (control and patients) consisted of males of similar age, height and body mass index (BMI); spirometric data were also similar in the four groups. There was no significative difference in the ratio of forced expiratory and inspiratory flows (FEF50 per cent/FIF50 per cent) in any group: control, 0.89; snorers, 1.11; snorers with OSA (AHI<20/h), 1.42, and snorers with OSA (AHI>20/h), 1.64. The FIF at 50 per cent of vital capacity (FIF50 per cent) of snoring patients with or without OSA was lower than the FIF50 per cent of the control group (P<0.05): snorers 4.30 l/s; snorers with OSA (AHI>20/h) 3.69 l/s; snorers with OSA (AHI>20/h) 3.17 l/s and control group 5.48 l/s. The FIF50 per cent of patients with severe OSA (AHI>20/h) was lower than the FIF50 per cent of snorers without OSA (P<0.05): 3.17 l/s and 4.30 l/s, respectively. We conclude that 1) the FEF50 per cent/FIF50 per cent ratio is not useful for predicting OSA, and 2) FIF50 per cent is decreased in snoring patients with and without OSA, suggesting that these patients have increased upper airway resistance (UAR).

Re-treatment with interferon alfa of patients with chronic hepatitis C.

Treatment of patients with chronic hepatitis C has had limited success because of relapses and nonresponse to interferon alfa therapy (currently the only established therapeutic agent). A retrospective study was done to determine the efficacy of re-treatment with interferon and the predictors of response in patients who failed to achieve sustained response after one standard course of interferon therapy (3 million units three times a week for 24 weeks). One hundred and eleven patients (47 relapsers and 64 nonresponders), mean age 45 years, were included in the study. Eighteen relapsers and 13 nonresponders received a higher dose (5 MU), and 11 relapsers and 6 nonresponders received a longer duration (48 weeks) of interferon therapy. The remaining patients received the same regimen as the first treatment. Eighty-one percent and 23% of relapsers and nonresponders, respectively, had an end-of-treatment response, and 19% and 3% of the corresponding patient groups had a sustained response to re-treatment. Two patients with breakthrough during their first treatment were the only nonresponders with sustained response after re-treatment. Sustained response was observed only in patients who received an increased dose or duration of interferon therapy. No predictor of sustained response was found. In conclusion, sustained response to re-treatment with interferon was only observed with augmentation of dose or duration of therapy in some relapsers and patients who had breakthrough. Established predictors of response to interferon in naive patients, in particular serum hepatitis C virus RNA and genotype, were not associated with sustained response to re-treatment.

Avaliaçäo da resposta ao broncodilatador em DPOC e asma / Bronchodilator response in asthma and obstructive bronchopulmonary disease

O presente trabalho constitui análise retrospectiva de 106 espirogramas, que estudou o comportamento de dois grupos de 53 pacientes cada, a saber, DPOC e asma brônquica (AB) diante do uso de broncodilatador (BCD) (fenotenol, 2 bombadas = 200 microgramas). Os resultados obtidos mostraram resposta significativa entre asmáticos (t < 0.05) em comparaçäo com a resposta discreta, mas existente, em pacientes com DPOC. O trabalho aponta como indicadores mais confiáveis para estimar a resposta ao broncodilatador, índice de Tifneau (p=0.43-DPOC e p=0.01-asma), o FEF 25/75 por cento p=0.78-DPOC e p=0.01-asma) e o VEF1 (p=0.37-DPOC e p=0.006-asma), sendo este o mais sensível entre os valores aferidos. Os resultados säo compatíveis com a literatura. Dos 53 casos de asma, 48 säo de ambulatório, 4 da enfermaria e um do Pronto Socorro. Quanto à distribuiçäo por sexo, observou-se prevalência, no DPOC, do sexo masculino da ordem de 41 em 53 casos, enquanto no grupo asma observou-se a prevalência feminina da ordem de 32 em 53 casos (Figura 1). O trabalho é útil para distinçäo simples entre DPOC e ASMA e confirma a expectativa de que a broncorresponsividade constitui atributo singular da asma, prevalente ao nível de grandes vias e com percentual médio de diferença (pré e pós uso de B.C.D.) em torno de 11 por cento