Infiltración de onabotulinumtoxin a para el tratamiento de la sialorrea en niños con diagnóstico de parálisis cerebral: estudio de casos / Onabotulinumtoxin a injection for the treatment of sialorrheain children with cerebral palsy: case series

Sialorrhea is a common oral motor impairment related to various neurological disorders such as cerebral palsy (CP), generating both physical and psychological complications that affect the quality of life of patients and their caregivers. Objective: To determine the clinical reduction of sialorrhea after injection with onabotulinumtoxin A (BTXA) in children diagnosed with CP. Methods: In 8 children 4-15 years of age, with GMFCS between II and V, injection with BTXA was performed in parotid and submandibular glands under ultrasound guidance. Measurement of salivation was made at baseline and 2, 4, 16, and 24 weeks post-infiltration through the Drooling Impact Scale (DIE), the Drooling Quotient (DQ) and the Drooling Severity and Frequency Scale (DSFS). Results: All children showed a significant reduction in salivation measured with the DQ (p < 0.002), the DIE (p < 0.002). Similarly, all children showed a 1 point reduction in the frequency subcomponent of the DSFS at 4 weeks post-injection. The severity subcomponent of DSFS showed a 1 point reduction only in the group of children with GMFCS II and IV. Conclusion: The use of BTXA in parotid and submandibular glands under ultrasound guidance is an effective intervention to reduce salivation, the severity and frequency of drooling, as well as the impact that sialorrhea has on patients and caregivers.

La sialorrea es consecuencia de una alteración motora oral frecuente en diversos trastornos neurológicos, como la parálisis cerebral (PC), generando complicaciones tanto físicas como psicosociales que impactan en la calidad de vida de los pacientes y sus cuidadores. Objetivo: Determinar la reducción clínica de sialorrea después de la infiltración de Onabotulinumtoxin A (BTXA) en niños con diagnóstico de PC. Pacientes y Métodos: En 8 niños de 4 a 15 años de edad, con GMFCS entre II y V, se realizó una infiltración con BTXA en glándulas parótida y submandibular bajo guía ecográfica. Se efectuó una medición basal de la salivación y en diferentes semanas post infiltración (2ª, 4ª, 8ª, 16ª y 24ª), a través de la Escala de Impacto de la Sialorrea (EIS), el Cociente de Salivación (DQ) y la Escala de Severidad y Frecuencia de la Sialorrea (DSFS). Resultados: Todos los niños presentaron una reducción significativa de la salivación en la evaluación con el DQ (p < 0,002) y la EIS (p < 0,002). En la DSFS en el subcomponente de frecuencia baja 1 punto posterior a la 4ª semana de infiltración en el total de los niños. En cambio, en el subcomponente de severidad baja 1 punto sólo en el grupo de GMFCS II y IV. Conclusión: El uso de BTXA en glándulas parótidas y submandibulares bajo guía ecográfica es un método de intervención efectivo para disminuir la salivación, la severidad y frecuencia de la sialorrea, así como el impacto que causa esta patología en los pacientes y cuidadores.

Microhemangiomas iridianos: a propósito de un caso / Iris microhaemangiomas: presentation of a case

CASO CLÍNICO: Mujer de 74 años que acude por cuadro de visión borrosa en el ojo derecho, de 12 h de evolución, no acompañada de otra sintomatología. En la exploración biomicroscópica se observa un hipema de 3 mm en el ojo derecho y múltiples estructuras nodulares vasculares en el margen iridiano de ambos ojos. DISCUSIÓN: Los microhemangiomas vasculares iridianos son anomalías vasculares no relacionadas con la isquemia que deben ser incluidas en el diagnóstico diferencial de hipema espontáneo

CASE REPORT: A 74 year-old woman present with blurry vision of 12 hour duration in her right eye, and with no other symptoms. Biomicroscopic examination revealed a 3 mm hyphaema in her right eye and multiple nodular structures in the pupillary margin of both eyes. DISCUSSION: Iris tufts are vascular anomalies unrelated to ischaemia that must be included in the differential diagnosis of spontaneous hyphaema

Ovarian hydatid disease.

Hydatid disease, also known as Echinococcosis is a zoonosis caused by the larval stage of Echinococcus. The human cystic variant primarily affects liver and lungs. The pelvic location of the disease is a rare finding usually secondary to a ruptured liver cyst, although it may also appear as a primary lesion affecting the genital organs. Despite its rarity, in endemic areas, pelvic hydatid disease should be considered in the differential diagnosis of complex adnexal cystic mass, to make an appropriate treatment strategy. The suspected diagnosis is based on imaging studies and serodiagnostic techniques, in which a new field of research attempts to find a standardized test with sufficient sensitivity and specificity. We report a case of primary pelvic hydatid disease in postmenopausal women operated for suspected ovarian cancer.

[Iris microhaemangiomas: presentation of a case]. / Microhemangiomas iridianos: a propósito de un caso.

CASE REPORT: A 74 year-old woman present with blurry vision of 12 hour duration in her right eye, and with no other symptoms. Biomicroscopic examination revealed a 3 mm hyphaema in her right eye and multiple nodular structures in the pupillary margin of both eyes. DISCUSSION: Iris tufts are vascular anomalies unrelated to ischaemia that must be included in the differential diagnosis of spontaneous hyphaema.

Parasite fauna of wild and cultured dusky-grouper Epinephelus marginatus (Lowe, 1834) from Ubatuba, southeastern Brazil / Fauna parasitária da garoupa selvagem e de cultivo Epinephelus marginatus (Lowe, 1834) em Ubatuba, sudeste do Brasil

This study aimed at identifying and quantifying the parasites of wild and cultured dusky grouper Epinephelus marginatus. During a year and thereby all four seasons, 20 wild and 20 cultured groupers were examined for the presence of parasites, except in the last season, in which 19 wild and 20 cultured fish were examined, totalling 159 groupers analysed from Ubatuba, southeastern Brazil. Prevalence, mean intensity of infection, mean abundance and mean relative dominance were calculated. Five species of parasites were identified in fish from both origins: Pseudorhabdosynochus beverleyburtonae (Monogenea), Neobenedenia melleni (Monogenea), Pseudempleurosoma sp. (Monogenea), Helicometrina nimia (Digenea) and larvae of Contracaecum sp. (Nematoda). The prevalence of ectoparasites, in most cases, was higher than endoparasites. The most abundant parasite was the monogenea Pseudorhabdosynochus beverleyburtonae in both wild and cultured fish, along all seasons. Neobenedenia melleni was observed in wild and cultured fish in all seasons, with a gradual increase in the number of parasites from the coldest to the hottest seasons, with the highest prevalence and mean intensity in the summer. Helicometrina nimia was found in all seasons in both wild and cultured fish, except for summer, where its presence was detected only in wild fish. Pseudempleurosoma sp. and larvae of Contracaecum sp. showed low prevalence occurring in wild and cultured fish in the autumn and spring, respectively. This study revealed high intensities of potentially pathogenic parasites that could favour disease outbreaks in culture conditions.

Este estudo teve como objetivo identificar e quantificar os parasitos da garoupa verdadeira Epinephelus marginatus selvagem e cultivada. Durante um ano, nas quatro estações, 20 garoupas selvagens e 20 cultivadas foram examinadas quanto à presença de parasitos, exceto na última estação, em que foram examinados 19 peixes selvagens e 20 cultivados, totalizando 159 peixes examinados em Ubatuba, Sudeste do Brasil. A prevalência, intensidade média de infecção, abundância média and dominância média relativa foram calculados. Cinco espécies de parasitos foram identificadas nos peixes de ambas as origens: Pseudorhabdosynochus beverleyburtonae (Monogenea), Neobenedenia melleni (Monogenea), Pseudempleurosoma sp. (Monogenea), Helicometrina nimia (Digenea) e larvas de Contracaecum sp. (Nematoda). A prevalência de ectoparasitos foi, na maioria das vezes, maior do que a de endoparasitos. O parasito mais abundante foi o monogenea Pseudorhabdosynochus beverleyburtonae em ambos os peixes selvagens e cultivados, durante todas as estações. Neobenedenia melleni foi observado e, peixes selvagens e cultivados em todas as estações, com aumento gradativo no número de parasitos das estações mais frias para as mais quentes, com as maiores prevalências e intensidades médias no verão. Helicometrina nimia foi encontrado em todas as estações em ambos os peixes selvagens e cultivados, exceto no verão, em que foi observada sua presença apenas em peixes selvagens. Pseudempleurosoma sp. e larvas de Contracaecum sp. apresentaram baixas prevalências, ocorrendo em peixes selvagens e cultivados no outono e na primavera, respectivamente. Este estudo revelou altas intensidades de parasitos potencialmente patogênicos que podem favorecer surtos de doenças em situações de cultivo.

Parasite fauna of wild and cultured dusky-grouper Epinephelus marginatus (Lowe, 1834) from Ubatuba, southeastern Brazil.

This study aimed at identifying and quantifying the parasites of wild and cultured dusky grouper Epinephelus marginatus. During a year and thereby all four seasons, 20 wild and 20 cultured groupers were examined for the presence of parasites, except in the last season, in which 19 wild and 20 cultured fish were examined, totalling 159 groupers analysed from Ubatuba, southeastern Brazil. Prevalence, mean intensity of infection, mean abundance and mean relative dominance were calculated. Five species of parasites were identified in fish from both origins: Pseudorhabdosynochus beverleyburtonae (Monogenea), Neobenedenia melleni (Monogenea), Pseudempleurosoma sp. (Monogenea), Helicometrina nimia (Digenea) and larvae of Contracaecum sp. (Nematoda). The prevalence of ectoparasites, in most cases, was higher than endoparasites. The most abundant parasite was the monogenea Pseudorhabdosynochus beverleyburtonae in both wild and cultured fish, along all seasons. Neobenedenia melleni was observed in wild and cultured fish in all seasons, with a gradual increase in the number of parasites from the coldest to the hottest seasons, with the highest prevalence and mean intensity in the summer. Helicometrina nimia was found in all seasons in both wild and cultured fish, except for summer, where its presence was detected only in wild fish. Pseudempleurosoma sp. and larvae of Contracaecum sp. showed low prevalence occurring in wild and cultured fish in the autumn and spring, respectively. This study revealed high intensities of potentially pathogenic parasites that could favour disease outbreaks in culture conditions.

Síndrome de Kounis / Kounis syndrome

El síndrome de Kounis (SK) fue descrito en 1991 por Kounis y Zavras como la aparición simultánea de eventos coronarios agudos y reacciones alérgicas anafilácticas o anafilactoides. Engloba conceptos como el de angina alérgica e infarto alérgico y se ha descrito en relación con picaduras de insectos, ingesta de fármacos y alimentos, exposiciones ambientales y condiciones médicas varias. Se desconoce su incidencia real ya que, la mayoría de la información proviene de casos clínicos o pequeñas series. En el presente artículo se exponen los aspectos clínicos, diagnósticos, fisiopatología y tratamiento de este síndrome (AU)

Kounis syndrome was described in 1991 by Kounis and Zavras as the coincidental occurrence of acute coronary syndromes with allergic reactions (anaphylactic or anaphylactoid). Today, allergic angina and allergic myocardial infarction are referred to as Kounis syndrome, and the latter has been reported in association with a variety of drugs, insect stings, food, environmental exposures and medical conditions, among other factors. The incidence is not known, as most of the available information comes from case reports or small case series. In this article, the clinical aspects, diagnosis, pathogenesis, related conditions and therapeutic management of the syndrome are discussed (AU)

[Conjunctival myeloid sarcoma in acute myeloblastic leukemia-M1]. / Sarcoma granulocítico conjuntival en leucemia mieloblástica aguda M1.

CLINICAL CASE: A 69-year-old man with a history of acute myeloblastic leukemia-M1 presented with bilateral conjunctival injection. Ophthalmological examination revealed lesions located at the upper tarsal conjunctiva of the right eye and lower tarsal conjunctiva of both eyes. Histological and immunohistochemical studies confirmed conjunctival myeloid sarcoma. The patient died due to multiorgan failure three months later. DISCUSSION: Extramedullary recurrence of leukemia can appear as an ocular manifestation that brings about a recurrence of the leukemia, leading to a poor prognosis.

Sarcoma granulocítico conjuntival en leucemia mieloblástica aguda M1 / Conjunctival myeloid sarcoma in acute myeloblastic leukemia-M1

Caso clínico: Varón de 69 años diagnosticado de leucemia mieloblástica aguda M1 en remisión completa, remitido a Oftalmología por cuadro de ojo rojo no doloroso. Biomicroscópicamente se observan lesiones sobreelevadas asalmonadas en conjuntiva tarsal superior de ojo derecho e inferior de ambos ojos. Mediante estudios histológicos e inmunohistoquímicos se confirma recidiva extramedular en forma de sarcoma mieloide en conjuntiva. El paciente fallece a los 3 meses de un fallo multiorgánico. Discusión: La recidiva extramedular de una leucemia puede presentarse como una manifestación ocular que conlleva una recurrencia de la leucemia, siendo esta de mal pronóstico(AU)

Clinical case: A 69-year-old man with a history of acute myeloblastic leukemia-M1 presented with bilateral conjunctival injection. Ophthalmological examination revealed lesions located at the upper tarsal conjunctiva of the right eye and lower tarsal conjunctiva of both eyes. Histological and immunohistochemical studies confirmed conjunctival myeloid sarcoma. The patient died due to multiorgan failure three months later. Discussion: Extramedullary recurrence of leukemia can appear as an ocular manifestation that brings about a recurrence of the leukemia, leading to a poor prognosis(AU)

[Kounis syndrome]. / Síndrome de Kounis.

Kounis syndrome was described in 1991 by Kounis and Zavras as the coincidental occurrence of acute coronary syndromes with allergic reactions (anaphylactic or anaphylactoid). Today, allergic angina and allergic myocardial infarction are referred to as Kounis syndrome, and the latter has been reported in association with a variety of drugs, insect stings, food, environmental exposures and medical conditions, among other factors. The incidence is not known, as most of the available information comes from case reports or small case series. In this article, the clinical aspects, diagnosis, pathogenesis, related conditions and therapeutic management of the syndrome are discussed.

Predicción de la utilidad clínica de la radiografía de tórax rutinaria en una unidad de cuidados intensivos de traumatología / Prediction of the clinical usefulness of routine chest X-rays in a traumatology ICU

IntroducciónEl valor de la radiografía torácica rutinaria está en cuestión. Sin embargo, este asunto no ha sido suficientemente evaluado en el caso concreto del paciente traumatizado. Nos propusimos encontrar predictores de utilidad en este entorno.Material y métodosEstudio observacional prospectivo en una UCI de traumatología de 8 camas. Se incluyeron los pacientes de más de 15 años, con traumatismo grave (ISS > 15), ingresados 48h o más. Se excluyeron las mujeres embarazadas y las radiografías no rutinarias. Un miembro del equipo médico examinó de manera independiente las placas, en busca de hallazgos radiográficos según se definían en una lista cerrada. Durante la ronda diaria, los médicos al cargo comunicaron cuantos cambios en el estado clínico y en el manejo ocurrieron tras la toma de la radiografía, también siguiendo una lista de criterios cerrados. La relación entre ambas variables se estudió por análisis univariante y multivariante.ResultadosDurante un año se obtuvieron 1.440 radiografías de 138 pacientes consecutivos. Predominaron los varones (82%), de edad joven (39±1 años). El 97% sufrieron traumatismo contuso; el 52%, traumatismo torácico grave. La estancia media se prolongó 12,9±10,1 días. En el 86,8% se empleó ventilación mecánica. De cada paciente se realizaron 10,4±9,3 placas. En el 14% hubo hallazgos relevantes, con mayor frecuencia una malposición de un dispositivo (6,8%) o infiltrados (4,9%), desencadenando una acción clínica en el (..) (AU)

AbstractBackground: The clinical value of routine chest X-rays in critical care has been questioned, buthas not been studied in the trauma environment to date. The objective of this study was toidentify easy to use clinical predictors of utility in this setting.Material and methods: A prospective observational study was made in an 8-bed traumatologyICU. Severe trauma patients (ISS > 15), aged 15 or older and admitted for 48 h or longer wereincluded. Pregnant women and radiographs obtained during initial care or for reasons otherthan routine indication were excluded. A staff physician, separated from clinical duties, independentlyreviewed the films in search of changes, as described in a closed checklist. Followingclosed criteria, the attending physicians reported previous day clinical events and changes inclinical management after chest X-ray obtainment. Demographic and epidemiological data werealso recorded. The associations among variables were studied by univariate and multivariateanalysis.Results: A total of 1440 routine chest X-rays were obtained from 138 consecutive patientsduring one year. Young males prevailed (82%; 39±16 years). The most common process wassevere blunt trauma (97%). Fifty-two percent suffered severe chest trauma. The mean lengthof stay was 12.9±10.1 days. Mechanical ventilation was used in 86.8% of the cases. A medianof 10.4±9.3 films were obtained from each patient. A total of 14% of the X-rays showed changes,most commonly malpositioning of an (..) (AU)

[Prediction of the clinical usefulness of routine chest X-rays in a traumatology ICU]. / Predicción de la utilidad clínica de la radiografía de tórax rutinaria en una unidad de cuidados intensivos de traumatología.

BACKGROUND: The clinical value of routine chest X-rays in critical care has been questioned, but has not been studied in the trauma environment to date. The objective of this study was to identify easy to use clinical predictors of utility in this setting. MATERIAL AND METHODS: A prospective observational study was made in an 8-bed traumatology ICU. Severe trauma patients (ISS > 15), aged 15 or older and admitted for 48 h or longer were included. Pregnant women and radiographs obtained during initial care or for reasons other than routine indication were excluded. A staff physician, separated from clinical duties, independently reviewed the films in search of changes, as described in a closed checklist. Following closed criteria, the attending physicians reported previous day clinical events and changes in clinical management after chest X-ray obtainment. Demographic and epidemiological data were also recorded. The associations among variables were studied by univariate and multivariate analysis. RESULTS: A total of 1440 routine chest X-rays were obtained from 138 consecutive patients during one year. Young males prevailed (82%; 39 ± 16 years). The most common process was severe blunt trauma (97%). Fifty-two percent suffered severe chest trauma. The mean length of stay was 12.9 ± 10.1 days. Mechanical ventilation was used in 86.8% of the cases. A median of 10.4 ± 9.3 films were obtained from each patient. A total of 14% of the X-rays showed changes, most commonly malpositioning of an indwelling device (6.8%) or infiltrates (4.9%). Those findings led to a change in care in 84.6% of the cases. Multivariate analysis identified the following significant (p < 0.05) risk factors for radiographic changes: first two days of evolution, mechanical ventilation, worsening of PaO2/FiO2, worsening of lung compliance and changes in respiratory secretions. CONCLUSIONS: Based on the results obtained, the risk of not identifying dangerous conditions by restricting routine chest X-rays prescription to the described conditions is low. Observing this policy would probably mean substantial savings and a reduction in radiation exposure.

Descontaminación: un tratamiento sin indicaciones / Decontamination. A treatment without indications

La prevención de la neumonía asociada a la ventilación mecánica (NAV) es un objetivo prioritario en las unidades de cuidados intensivos (UCI). Para conseguirlo, las guías de práctica clínica recomiendan la aplicación simultánea de un conjunto heterogéneo de medidas que ha mostrado su efectividad, de manera que en la actualidad se asiste a una reducción de la incidencia de la NAV hasta cifras que hasta hace poco se consideraban inalcanzables; un mayor cumplimiento de las guías de práctica clínica se ha traducido en múltiples estudios en tasas de NAV que se aproximan a cero. Frente a las medidas recomendadas en las guías de práctica clínica, la descontaminación digestiva selectiva (DDS), aplicada junto con otras medidas de control de infecciones, ha mostrado eficacia en hospitales con elevada incidencia basal de neumonía, pero su efectividad en hospitales con buen cumplimiento de las guías de práctica clínica y tasas bajas de NAV es altamente improbable. Un serio inconveniente de la DDS es el riesgo de favorecer la selección de microorganismos resistentes, que pueden diseminarse fácilmente por la unidad de cuidados intensivos y el hospital. Con los estándares actuales de prevención de infecciones, la DDS es una medida innecesaria y de riesgo, que no debe emplearse de manera generalizada. Aún no se conoce en qué situaciones la DDS puede aumentar la efectividad de las medidas preventivas estándares correctamente aplicadas (AU)

The prevention of ventilator-associated pneumonia (VAP) is a priority in the Intensive Care Unit (ICU). To achieve this goal, clinical practice guidelines recommend the simultaneous application of a heterogeneous group of preventive measures of proven effectiveness. That is why we are presently seeing a reduction in VAP incidence to values previously considered unreachable. Better compliance with clinical practice guidelines has resulted in VAP rates approaching zero in multiple studies. Faced with the measures recommended in these guidelines, selective digestive decontamination (SDD), used together with other infection control practices, has shown efficacy in hospitals with high baseline incidence of pneumonia. However, its effectiveness in hospitals with good compliance of clinical practice guidelines and lower rates of VAP is highly unlikely. A serious drawback of DDS is the risk of favoring the selection of resistant microorganisms that can spread easily through the ICU and the hospital. With current standards of infection prevention, DDS is an unnecessary and risky measure, which should not be used on a widespread basis. Those situations in which the DDS may increase the effectiveness of properly implemented standard measures are still unknown (AU)

[Decontamination. A treatment without indications]. / Descontaminación: un tratamiento sin indicaciones.

The prevention of ventilator-associated pneumonia (VAP) is a priority in the Intensive Care Unit (ICU). To achieve this goal, clinical practice guidelines recommend the simultaneous application of a heterogeneous group of preventive measures of proven effectiveness. That is why we are presently seeing a reduction in VAP incidence to values previously considered unreachable. Better compliance with clinical practice guidelines has resulted in VAP rates approaching zero in multiple studies. Faced with the measures recommended in these guidelines, selective digestive decontamination (SDD), used together with other infection control practices, has shown efficacy in hospitals with high baseline incidence of pneumonia. However, its effectiveness in hospitals with good compliance of clinical practice guidelines and lower rates of VAP is highly unlikely. A serious drawback of DDS is the risk of favoring the selection of resistant microorganisms that can spread easily through the ICU and the hospital. With current standards of infection prevention, DDS is an unnecessary and risky measure, which should not be used on a widespread basis. Those situations in which the DDS may increase the effectiveness of properly implemented standard measures are still unknown.

Epidemiología de los estados hipertensivos del embarazo / Epidemiology of hypertension during pregnancy

A lo largo del siglo pasado se han realizado innumerables publicaciones y trabajos científicos sobre la hipertensión asociada al embarazo, pero todavía se desconoce la causa primitiva que la origina y su fisiopatología no está totalmente aclarada. Objetivos: Conocer la incidencia actual de los estados hipertensivos del embarazo (EHE) en nuestro medio y establecer los factores epidemiológicos involucrados en los EHE, con el objeto de elaborar un perfil tipo de gestante de riesgo. Resultados: La frecuencia de EHE fue del 2,55%. La hipertensión gestacional fue la forma más frecuente (52,30%), seguida de la preeclampsia grave (20%), la preeclampsia leve (16,92%), la HTA crónica (6,15%), la preeclampsia sobre añadida a HTA crónica (3,07%) y laeclampsia (1,53%). Entre las variables epidemiológicas estudiadas solamente han mostradosignificación estadística la edad igual o superior a 35 años, la nuliparidad, la razacaucásica, el nivel educativo alto y la actividad laboral (AU)

Throughout the past century, countless publications and scientific studies were carried out on hypertension during pregnancy. However, the primary cause and physiopathology of this disorder remains to be elucidated Objectives: To determine the current incidence of hypertension during pregnancy (HP) in our environment. To identify the epidemiological factors involved in HP in order to developa profile of pregnant women a trisk. Results: The frequency of HP was 2.55%. The most common form was gestational hypertension (52.30%), followed by severe preeclampsia(20%), mild preeclampsia(16.92%), chronic hypertension(6.15%), chronic hypertension complicated by preeclampsia (3.07%)and eclampsia (1.53%). Among the epidemiologic variables studied, only age equal or superior to 35 years, nulliparity, Caucasian race, a high level of education, and occupation were statistically significant (AU)

[Loco-regional analgesia]. / Analgesia locorregional.

The epidural analgesia is one of the most effective techniques for pain relief when it is indicated, but it can present potentially serious complications that must precociously be diagnosed and be treated. In the Critical Care setting, epidural analgesia is used for pain control after surgery or major trauma. The technique is simple, a catheter is placed into a virtual cavity, so the administered drugs are absorbed through the epidural space into nerve roots. The administration of local anesthetics, opioids or the combination of both by epidural route (administered in continuous infusion or bolus), provides better analgesia. Also the clonidine can be used. In order to diagnose and to treat suitably the possible complications (pain, urinary retention, nauseas and vomits, itching, motor block, infection, respiratory depression, hypotension) a series of safety measures must be adopted (respiratory and heart rate, blood pressure, sedation score, sensory and motor level assessment, rate of diuresis, temperature and signs of infection).

Analgesia locorregional / Loco-regional analgesia

La analgesia epidural es una de las técnicas más eficaces para el alivio del dolor cuando está indicada, pero puede presentar complicaciones potencialmente graves que deben ser diagnosticadas y tratadas precozmente. Se emplea en Medicina Intensiva en el control del dolor posoperatorio y tras traumatismo grave. La técnica es sencilla: se coloca un catéter en una cavidad virtual permitiendo que los anestésicos locales difundan hasta las raíces nerviosas raquídeas. La administración de anestésicos locales, opiáceos o la combinación de ambos por vía epidural (ad- ministrados de forma intermitente o en infusión continua) proporciona una mejor analgesia. También puede emplearse la clonidina. Para diagnosticar y tratar adecuadamente las posibles complicaciones (dolor, retención urinaria, náuseas y vómitos, prurito, bloqueo motor, infección, depresión respiratoria e hipotensión) deben adoptarse una serie de medidas de seguridad (monitorización respiratoria y hemodinámica, nivel de consciencia, nivel sensitivo, ritmo de diuresis y signos de infección) (AU)

The epidural analgesia is one of the most effective techniques for pain relief when it is indicated, but it can present potentially serious complications that must precociously be diagnosed and be treated. In the Critical Care setting, epidural analgesia is used for pain control after surgery or major trauma. The technique is simple, a catheter is placed into a virtual cavity, so the administered drugs are absorbed through the epidural space into nerve roots. The administration of local anesthetics, opioids or the combination of both by epidural route (administered in continuous infusion or bolus), provides better analgesia. Also the clonidine can be used. In order to diagnose and to treat suitably the possible complications (pain, urinary retention, nauseas and vomits, itching, motor block, infection, respiratory depression, hypotension) a series of safety measures must be adopted (respiratory and heart rate, blood pressure, sedation score, sensory and motor level assessment, rate of diuresis, temperature and signs of infection) (AU)

Renal transplantation in diabetic patients.

OBJECTIVE: Diabetes is one of the main causes of end-stage renal disease (ESRD) and admission to hemodialysis, and the demand for kidney transplantation in this population has increased. Our aim was to evaluate the clinical aspects and survival of diabetic patients with kidney transplants by comparing them with the nondiabetic population. MATERIALS AND METHODS: Patients transplanted during the period from 1994 to 2003 were evaluated for this study. The transplant and demographic characteristics were analyzed by the chi-square test and Student t test according to the type of variable. Kaplan-Meier curves and the log-rank test were used to evaluate the graft and patient survival. RESULTS: From a total of 523 consecutive renal transplants, 35 (6.6%) were diabetics who were older than nondiabetics (47 +/- 11 years vs 37 +/- 16, P < .002). Patients received immunosuppression with cyclosporine (84.3%), tacrolimus (11.2%), azathioprine (46.6%), mycophenolate mofetil (43.5%), and steroids (all patients). The diabetic patients had a higher percentage of living donors (33.5% vs 17.2%; P = .04). Graft survival rates at 1, 3, and 5 years were 82.7%, 70.9%, and 63.0% in the diabetic patients and 87.6%, 79.0%, and 72.5% (P = .6) in the nondiabetic patients. Patient survival at 5 years was 90.5% in diabetic patients vs 89.0% in nondiabetic patients (P = .9). CONCLUSIONS: No differences were found in our series in transplant complications or survival in the diabetic patients compared with the nondiabetic patients. Kidney transplants, even with living donors, must be offered to well-selected diabetic patients without reservations.

Infección urinaria temprana en trasplante renal. Factores de riesgo y efecto en la sobrevida del injerto / Early urinary tract infection in kidney transplantation. Risk factors and impact on graft survival

The early urinary tract infection (EUTI) in kidney transplant recipients is an infection develop during the first 3 months post transplant surgery. The effect of EUTI on graft survival and risk factors have been scarcely studied. Our objetives were the evaluation of risk factors to EUTI, the assessment of the causal agent and graft survival impact. A retrospective analysis of kidney transplantation, period 1997-2000 in Hospital Privado-Centro Médico de Córdoba was carried out. There were two groups of patients with (EUTI group) and without EUTI (control group). Cox model was used to analyze risk factors and Kaplan-Meier method for graft survival. A total of 226 consecutive patients received kidney transplantation. In 55 patients (24.3%) EUTI was detected. Risk factors for EUTI were: invasive urological maneuvers (RR = 4.34, CI 95% 1.42-13.21), diabetes mellitus (RR = 3.79, CI 95% 1.42-10.14), cytomegalovirus infection (RR = 2.9, CI 95% 1.02-8.24) and previous transplants (RR = 2.83, CI 95% 1.08-7.45). Delayed graft function was associated with lower incidence of EUTI (RR = 0.38, CI 95% 0.15-0.94). The causal agents were: Klebsiella pneumoniae (36%), Pseudomonas aeruginosa (24%) and Escherichia coli (9%). Graft survival at 2 years was similar in EUTI (87.2%) and control group (81.2%, p = 0.32). This series shows that invasive urological maneuvers were the main risk factors for EUTI. Graft survival was similar. High prevalence of non coli bacteria need further evaluation.

La infección urinaria temprana del injerto (IUTI), definida como infección urinaria sintomática en los primeros 3 meses del trasplante, su efecto sobre la sobrevida del injerto y los factores de riesgo han sido poco estudiados. Los objetivos del presente análisis fueron conocer factores de riesgo para IUTI,analizar agentes causantes e impacto en la sobrevida del injerto. En forma retrospectiva se analizaron pacientesque recibieron trasplante renal durante 1997-2000 en el Hospital Privado – Centro Médico de Córdoba. Sedividió en dos grupos de pacientes, según presencia (grupo IUTI) o ausencia (grupo control) de IUTI. Los factores de riesgo se analizaron con el modelo de riesgos proporcionales de Cox y la sobrevida del injerto con elmétodo de Kaplan-Meier. Recibieron trasplante renal 226 pacientes consecutivos. La IUTI se presentó en 55(24.3%). Factores de riesgo asociados con IUTI: antecedentes de maniobras urológicas invasivas (RR=4.34,IC 95% 1.42-13.21), diabetes mellitus (RR=3.79, IC 95% 1.42-10.14), infección por citomegalovirus (RR=2.9,IC 95% 1.02-8.24) y antecedente de trasplante previo (RR=2.83, IC 95% 1.08-7.45). El retardo en la función delinjerto (RR=0.38, IC 95% 0.15-0.94) se asoció con menor incidencia de IUTI. Agentes más frecuentes: Klebsiellapneumoniae (36%), Pseudomonas aeruginosa (24%) y Escherichia coli (9%). La sobrevida del injerto a los 2años en el grupo IUTI (87.2%) no fue diferente del control (81.2%, P = 0.32). En esta serie las maniobras urológicas invasivas fueron el principal factor de riesgo asociado a IUTI. No hubo disminución de la sobrevida del injerto asociada a IUTI. La alta prevalencia de uropatógenos no coli requiere mayor evaluación

Infección urinaria temprana en trasplante renal. Factores de riesgo y efecto en la sobrevida del injerto / Early urinary tract infection in kidney transplantation. Risk factors and impact on graft survival

The early urinary tract infection (EUTI) in kidney transplant recipients is an infection develop during the first 3 months post transplant surgery. The effect of EUTI on graft survival and risk factors have been scarcely studied. Our objetives were the evaluation of risk factors to EUTI, the assessment of the causal agent and graft survival impact. A retrospective analysis of kidney transplantation, period 1997-2000 in Hospital Privado-Centro Médico de Córdoba was carried out. There were two groups of patients with (EUTI group) and without EUTI (control group). Cox model was used to analyze risk factors and Kaplan-Meier method for graft survival. A total of 226 consecutive patients received kidney transplantation. In 55 patients (24.3%) EUTI was detected. Risk factors for EUTI were: invasive urological maneuvers (RR = 4.34, CI 95% 1.42-13.21), diabetes mellitus (RR = 3.79, CI 95% 1.42-10.14), cytomegalovirus infection (RR = 2.9, CI 95% 1.02-8.24) and previous transplants (RR = 2.83, CI 95% 1.08-7.45). Delayed graft function was associated with lower incidence of EUTI (RR = 0.38, CI 95% 0.15-0.94). The causal agents were: Klebsiella pneumoniae (36%), Pseudomonas aeruginosa (24%) and Escherichia coli (9%). Graft survival at 2 years was similar in EUTI (87.2%) and control group (81.2%, p = 0.32). This series shows that invasive urological maneuvers were the main risk factors for EUTI. Graft survival was similar. High prevalence of non coli bacteria need further evaluation.(AU)

La infección urinaria temprana del injerto (IUTI), definida como infección urinaria sintomática en los primeros 3 meses del trasplante, su efecto sobre la sobrevida del injerto y los factores de riesgo han sido poco estudiados. Los objetivos del presente análisis fueron conocer factores de riesgo para IUTI,analizar agentes causantes e impacto en la sobrevida del injerto. En forma retrospectiva se analizaron pacientesque recibieron trasplante renal durante 1997-2000 en el Hospital Privado ¹ Centro Médico de Córdoba. Sedividió en dos grupos de pacientes, según presencia (grupo IUTI) o ausencia (grupo control) de IUTI. Los factores de riesgo se analizaron con el modelo de riesgos proporcionales de Cox y la sobrevida del injerto con elmétodo de Kaplan-Meier. Recibieron trasplante renal 226 pacientes consecutivos. La IUTI se presentó en 55(24.3%). Factores de riesgo asociados con IUTI: antecedentes de maniobras urológicas invasivas (RR=4.34,IC 95% 1.42-13.21), diabetes mellitus (RR=3.79, IC 95% 1.42-10.14), infección por citomegalovirus (RR=2.9,IC 95% 1.02-8.24) y antecedente de trasplante previo (RR=2.83, IC 95% 1.08-7.45). El retardo en la función delinjerto (RR=0.38, IC 95% 0.15-0.94) se asoció con menor incidencia de IUTI. Agentes más frecuentes: Klebsiellapneumoniae (36%), Pseudomonas aeruginosa (24%) y Escherichia coli (9%). La sobrevida del injerto a los 2años en el grupo IUTI (87.2%) no fue diferente del control (81.2%, P = 0.32). En esta serie las maniobras urológicas invasivas fueron el principal factor de riesgo asociado a IUTI. No hubo disminución de la sobrevida del injerto asociada a IUTI. La alta prevalencia de uropatógenos no coli requiere mayor evaluación(AU)