[Utility of bispectral vs auditory evoked potential monitoring during anesthetic maintenance in combined sevoflurane-regional anesthesia in pediatric patients: comparison with standard practice]. / Utilidad del BIS y AEP monitor/2 para el mantenimiento de la anestesia combinada sevoflurano-regional, comparada con la práctica estándar en población pediátrica.

OBJECTIVES: To compare the indices computed by a bispectral (BIS) monitor and an auditory evoked potential (AEP) monitor during maintenance of anesthesia in pediatric patients. A secondary objective was to compare anesthetic consumption and recovery times. MATERIAL AND METHODS: Patients aged 6 months to 12 years under inhaled anesthesia with sevoflurane were administered a penile or caudal nerve block. BIS and AEP monitoring was then started. The patients were randomized to 3 groups in which the sevoflurane dosage was guided by the BIS index, the A-line ARX index (AAI), or standard procedures (control group). The BIS index, the AAI, the fraction of expired sevoflurane, hemodynamic parameters, and recovery time were the variables recorded for all patients. RESULTS: Thirty-five patients were enrolled. Significant differences between the 2 monitor groups were observed. The mean (SD) AAI was lower in patients whose dosage was controlled by the BIS index (19 [2]) than in those whose dosage was based on the AEP monitor's reading (22 [4]) (P=.04). According to a Bland and Altman plot, there was good agreement between the BIS index and the AAI except for the highest and, in particular, the lowest values. The volumes of sevoflurane used and the recovery times were similar between groups. There was a positive correlation between the 2 indices (Pearson correlation coefficient, 0.207; P<.001). CONCLUSIONS: BIS monitoring provided a more stable index than did AEP monitoring and BIS-index guidance achieved a deeper level of hypnosis. There was good correlation between the 2 indices during maintenance of anesthesia. Neither monitor offered advantages over standard procedures with regard to movement, volume of anesthetic consumed, or recovery time.

Utilidad del BIS® y AEP Monitor/2® para el mantenimientode la anestesia combinada sevoflurano-regional, comparadacon la práctica estándar en población pediátrica / Utility of bispectral vs auditory evoked potential monitoring during anesthetic maintenance in combined sevofluraneregional anesthesia in pediatric patients: comparison with standard practice

OBJETIVOS: Evaluación comparativa de los índices proporcionadospor BIS® y AEP Monitor® durante el mantenimientode la anestesia en pacientes pediátricos. Objetivossecundarios comparar el consumo anestésico y eltiempo de despertar.MATERIAL Y MÉTODO: Pacientes con edades entre 6 mesesy 12 años sometidos a anestesia inhalatoria con sevoflurano,bloqueo nervioso peneano o caudal y monitorizacióncon BIS®‚ y AEP Monitor®. Se aleatorizaron en tres grupossegún el monitor utilizado para dosificar sevoflurano:grupo BIS, grupo AAI y control. Se recogieron automáticamenteBIS y AAI, fracción espirada de sevoflurano, parámetroshemodinámicos y tiempo de despertar.RESULTADOS: Se incluyeron 35 pacientes. Se encontrarondiferencias significativas entre los índices recogidosdependiendo del monitor utilizado. El AAI fue más bajoen el grupo controlado por BIS respecto al controlado porAEP Monitor/2 (media [SD], 19 [2] vs 22 [4]; p=0,04).Hubo una buena concordancia entre BIS y AAI salvo enlos valores extremos, sobre todo, los inferiores (ecuaciónde Bland-Altman). El consumo de sevoflurano y el tiempode despertar no fueron diferentes entre grupos. Se estableciócorrelación positiva entre los dos índices (coeficientede correlación de Pearson 0,207; p<0,001).CONCLUSIONES: La guía de la anestesia con BIS, respectoal AEP Monitor proporcionó un índice más establey profundizó más la hipnosis. Ambos índices presentaronuna buena correlación durante el mantenimiento. Ningunode los monitores presentó ventajas respecto a unapráctica clínica estándar en la incidencia de movimiento,gasto anestésico o tiempo de despertar (AU)

OBJECTIVES: To compare the indices computed by abispectral (BIS) monitor and an auditory evoked potential(AEP) monitor during maintenance of anesthesia inpediatric patients. A secondary objective was to compareanesthetic consumption and recovery times.MATERIAL AND METHODS: Patients aged 6 months to 12years under inhaled anesthesia with sevoflurane wereadministered a penile or caudal nerve block. BIS and AEPmonitoring was then started. The patients were randomized to3 groups in which the sevoflurane dosage was guided by theBIS index, the A-line ARX index (AAI), or standardprocedures (control group). The BIS index, the AAI, thefraction of expired sevoflurane, hemodynamic parameters,and recovery time were the variables recorded for all patients.RESULTS: Thirty-five patients were enrolled.Significant differences between the 2 monitor groupswere observed. The mean (SD) AAI was lower in patientswhose dosage was controlled by the BIS index (19 [2])than in those whose dosage was based on the AEPmonitor's reading (22 [4]) (P=.04). According to a Blandand Altman plot, there was good agreement between theBIS index and the AAI except for the highest and, inparticular, the lowest values. The volumes of sevofluraneused and the recovery times were similar betweengroups. There was a positive correlation between the 2indices (Pearson correlation coefficient, 0.207; P<.001).CONCLUSIONS: BIS monitoring provided a more stableindex than did AEP monitoring and BIS-index guidanceachieved a deeper level of hypnosis. There was goodcorrelation between the 2 indices during maintenance ofanesthesia. Neither monitor offered advantages overstandard procedures with regard to movement, volumeof anesthetic consumed, or recovery time (AU)

[Genitourinary rhabdomyosarcoma in childhood]. / Rabdomiosarcomas genitourinarios en la infancia.

We present the result obtained by GICOP in the treatment of 12 genitourinary rhabdomyosarcoma, located in vagina-uterus (5), bladder-prostate (4) and paratesticular (3). The age of the patients ranging from 1 to 15 years. Embryonal rhabdomyosarcoma was the most common histologic type (58 for 100) being the major number of cases in stadium II. The treatment was based in the combination of chemotherapy protocolised with vincristine, d-actinomycin, cyclophosphamide (VAC), vincristine, adriamycin (VAC-VAD) and/or iphosphamide, vincristine, d-actinomycin (IVA), use of radiotherapy, marrow auto-transplantation and radical surgery avoidance. Complete remission was achieved in 11 out of 12 cases (92 for 100), relapsing in 5 cases (38 for 100) of which 4 (80 for 100) achieved a second remission. An 82 for 100 disease free survival was achieved in a 5 year period.

[Non-Hodgkin's lymphomas in childhood. Evaluation of therapeutic results according to histopathologic criteria (Catalan Interhospital Group of Pediatric Oncology)]. / Linfomas no Hodgkin en la infancia. Valoración de resultados terapéuticos según criterios histopatológicos (GICOP).

The results obtained in the treatment of 37 children with non Hodgkin lymphoma belonging to GICOP between january 1982 and december 1986 are analysed. The therapy depend on the anatomopathology following the working formulation; LSALL2 protocol is used in lymphoblastic lymphoma, Burkitt-82 in undifferentiated Burkitt lymphoma and COMP in the remaining complete remission was archived in 94.6%. Murphy's classification is used. Disease free survival is 81% at 30 months. The actuarial survival is 0.81 for LL and 0.84 for BK at 48 months. The results obtained in the treatment of Burkitt's lymphoma with Burkitt-82 protocol and specially the absence of CNS infiltration are remarkable.

[Tumors of the CNS in childhood]. / Tumores de SNC en la infancia.

Brain tumors are the most common group of solid malignancies in childhood. The therapeutic arms available nowadays: surgery, radiotherapy and chemotherapy, have achieved considerable improvement in the survival of some types of CNS tumors, mainly due to the first two. We have carried out a retrospective study of 252 CNS tumors, diagnosed in the GICOP group during the last ten years. The primary location was: supratentorial, 42%; infratentorial, 51%; and both, 7%. Biopsies were performed in 190 cases (75%), resulting in the following histologic types: astrocytoma (38%), medulloblastoma (19%), ependymoma (14%), craniopharyngioma (7%), others (22%). The treatment was individualized according to the patient characteristics: age, location, histologic type and tumor spreading. Surgery was performed in 82% of patients (8% only derivative shunt), radiotherapy in 48% and chemotherapy in 23%. The life survival was 60% at 50 months.

Computed tomography of infantile hepatic hemangioendothelioma.

Computed tomography (CT) was performed on five infants with hepatic hemangioendothelioma. Precontrast scans showed solitary or multiple, homogeneous, circumscribed areas with reduced attenuation values. Tiny tumoral calcifications were identified in two patients. Serial scans, after injection of a bolus of contrast material, showed early massive enhancement, which was either diffuse or peripheral. On delayed scans, multinodular tumors became isodense with surrounding liver, while all solitary ones showed varied degrees of centripetal enhancement and persistent central cleftlike unenhanced areas. The authors believe that these CT features are characteristic and obviate arteriographic confirmation.