[Surgical and nutritional evaluation of children with percutaneous endoscopic gastrostomy]. / Evaluación quirúrgica y nutricional de los niños con gastrostomía endoscópica percutánea.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) has suppoused an improvement in the nutritional management of patients with deglution difficulty. Surgical and nutritional aspects have been evaluated in our patients with PEG. MATERIAL AND METHODS: A descriptive retrospective study with individual analysis of surgical, nutritional and satisfaction items has been developed. RESULTS: 83 PEG (1994-08) have been implanted in neurological patients (63.8%) followed by cystic fibrosis; Mean age 7 years (4 months-25 years). Two patients have a ventriculo-peritoneal shunt (VPS) and 3 a peritoneal dialysis catheter (PDC). 12% had a mild complication and 3 patients a severe one, with 2 reinterventions performed. 40 patients have the dispositive, 25 were removed after a mean follow-up of 2,5 years and 17 patients dies. Nutrition was done with initial, continuation or specials formulas. Weight evaluation was satisfactory in 96% of patients and biochemical indicators were normalized in 97% of them. Satisfaction is very high among the majority of parents. CONCLUSIONS: PEG is a technique that allows nutritional recuperation with few surgical complications. VPS and PDC are not contraindications for the percutaneous gastrostomy. PEG improves children and relatives life quality.

[Fast track antibiotic protocol in acute appendicitis]. / Protocolo antibiótico "fast-track" en la apendicitis aguda.

INTRODUCTION: The increase of antimicrobial resistances, has affected the efficacy of antimicrobial triple therapy, increasing appendicitis morbidity. We decided to change to a fast-track protocol of 72 hours of Cefuroxime-Metronidazol or Ertapenem. AIM: to know if our infectious morbidity rate has improved and if early dischargement is possible. MATERIAL AND METHODS: Analytic historic cohort study: Historical cohort (HC): patients intervened of appendicitis between October 2005 and October 2006. Current cohort (CC): started in June 2007. A data collection protocol is designed for both groups. Homogeneity among cohorts is proved and data are analysed (a=0,05). Statistics are analyzed by SPSS 15.0. RESULTS: 226 patients were controlled, being 110 complicated appendicitis (HC: 61/135; AC: 49/91). There are no differences among cohorts about evolution time, temperature and leukocytes rate at admission, interval to intervention, use of laparoscopy, drainage or antimicrobial prophylaxis. There is difference about the use of pre-surgical ultrasound. Admission rate has been reduced in 2.82 days, from 8.41 days in HC to 5.58 with the new antimicrobial protocol (median 7 to 4). The relative risk of developing intraabdominal abscess is 0.366 (HC: 15.7%; CC: 6.4%) (p=0.145) and readmission rate has been reduced from 9.8% to 0% (p=0.028). In 33% of cultures we have found different levels of antimicrobial resistance. No Enterococcus has been isolated. CONCLUSIONS: 1) Infectious morbidity rate has decreased with the new therapy. 2) Antimicrobial resistance and new antibiotics have exceeded Triple antimicrobial therapy. 3) It is possible an early dischargement in perforated appendicitis without an increasing of readmission rate. 4) We must know the bacterial flora in order to adapt our antibiotic therapy.