Resultados a largo plazo de pacientes con herniadiafragmática congénita / Long-term results of patients with congenital diaphragmatic hernia

Introducción. La introducción de avanzadas modalidades terapéuticas ha permitido alcanzar mejorías considerables en la supervivencia de la hernia diafragmática congénita (HDC). Sin embargo, existen pocos estudios que analicen la evolución clínica de los supervivientes a largo plazo. El objetivo de este trabajo es analizar la evolución a largo plazo de una serie de pacientes diagnosticados de HDC en nuestro hospital. Material y métodos. Entre 1998 y 2005 fueron tratados en nuestro centro 55 neonatos afectos de HDC. La supervivencia al alta hospitalaria fue del 72% (40 pacientes), siendo estos los incluidos en el estudio. En 6de ellos se requirió ECMO durante el tratamiento neonatal. Realizamos un estudio descriptivo transversal mediante revisión exhaustiva del historial clínico y encuesta telefónica a los padres, analizando las alteraciones respiratorias, cardiológicas, digestivas y el estado neurológico actual, utilizando para ello los métodos diagnósticos estándar en cada caso. La edad media de los niños en el momento del estudio es 4,2 años (1-9). Resultados. El 8,3% de los niños requirió oxigenoterapia domiciliaria, retirándose a los 3 meses en todos los casos. Ingresaron por problemas respiratorios el 22%, siendo la bronquiolitis y neumonía los diagnósticos más frecuentes. Solo un paciente padece asma de esfuerzo. El reflujo gastroesofágico es la patología más frecuente a largo plazo (47%), pero solo requiere tratamiento quirúrgico el 8,3%.En el ámbito cardiológico, el 14% padece hipertensión pulmonar, siendo leve-moderada en todos los casos excepto 1 niño que falleció (..) (AU)

Objective. Introduction of advanced therapeutic modalities fordiaphragmatic congenital hernia (CDH) has allowed to reach considerable improvements in survival rate. Nevertheless, there are few studies which analyze the clinical evolution of the long-term survivors. The aim of this work is to analyze the outcomes of the patients with CDH in our hospital. Methods. Fifty-five neonates with CDH were treated in our center between 1998 and 2005. We included in the study those patients that were alive at the moment of first hospital discharge (72%; n = 40patients). ECMO therapy was needed in 6 of them during neonatal treatment. A descriptive transverse review of the clinical record as well as a telephonic interview to the parents was performed for the respiratory, cardiological, digestive and neurological conditions, following standard diagnostic studies in every case. The mean age of the children in the moment of the study was 4.2 years (1-9).Results. The 8.3% of the children needed domiciliary oxygen therapy during a maximum of 3 months in all the cases. 22% of the cases suffered from respiratory problems, being bronchiolitis and pneumonia the most frequent diagnoses. Only a patient developed asthma. The gastroesophageal reflux is the most frequent long-term condition (47%),but only 8.3% needs surgical treatment. Regarding to cardiological problems, 14% developed pulmonary hypertension, being slight - moderate (..) (AU)

[Is it correct to use neonatal intensive care units as operating rooms?]. / Es adecuado utilizar las Unidades de Cuidados Intensivos Neonatales como sala de operaciones?

AIM: The neonatal intensive care unit (NICU) is used in many centres as operating room in order to avoid the co-morbidities that there produces the movement of critical patients. The motive of this work is to analyze the advantages and disadvantages of this type of surgical interventions. METHODOLOGY: Between January, 2004 and December, 2007 405 newborns were operated in the NICU. The most frequent surgical realized interventions were: deferred closing breastbone (172), placement of ECMO (42), ligation of patent ductus arteriosus (45), laparotomies for necrotising enterocolitis (27), repair of congenital diaphragmatic hernia (20), plicate of diaphragms (5) and closing of gastroschisis (4). We realize a retrospective study of a group of 40 patients operated by diaphragmatic hernia and necrotising enterocolitis in the UCIN (group A) and compare them with a group of patients operated in the operating room with the same pathology (group B). We study 22 variables preoperatory, intraoperatory and postoperatory. For the statistical analysis T-student and Chi-square was in use, being considered to be statistically significant p < 0.05. RESULTS: The average ages of the patients to the intervention were 11.1 +/- 8 days being the predominant sex the masculine one (60 %). The age gestational and the average weight for the group A was 31.9 +/- 5.7 weeks and 1,735 +/- 123 grams being for the group B of 34 +/- 3.5 weeks and 2,037 +/- 728 grams respectively (p = N.S.). 89.3% of the patients of the group A was with intubation orotracheal before the surgery, being 57.2% for the group B. The needs of high frequency ventilation and vasoactives drugs were higher for the group A (p < 0.01) and the operative time was similar in both groups (81 +/- 34 vs. 98 +/- 33 minutes). We find a difference of corporal temperature pre-post surgery of 0.60 +/- 0.48 degrees C for the group A and 2.18 +/- 0.93 degrees C in the B (p < 0.01). We don't estimate differences as for episodes of infection of wound, intraabdominal infection or need of reintervention. The survival of the patients was discreetly higher for the group operated in the operating room (82.3%) with regard to the group operated in the NICU (60%) without statistically significant differences existed. CONCLUSIONS: In our experience the NICU is a suitable place to realize surgical interventions in critical patients. The higher mortality for the group controlled in the UCIN explains for a major instability preoperatory. The maintenance of the corporal temperature avoiding the hypothermia it's one of the decisive factors to diminish the morbi-mortality.

[Long-term results of patients with congenital diaphragmatic hernia]. / Resultados a largo plazo de pacientes con hernia diafragmáitica congénita.

OBJECTIVE: Introduction of advanced therapeutic modalities for diaphragmatic congenital hernia (CDH) has allowed to reach considerable improvements in survival rate. Nevertheless, there are few studies which analyze the clinical evolution of the long-term survivors. The aim of this work is to analyze the outcomes of the patients with CDH in our hospital. METHODS: Fifty-five neonates with CDH were treated in our center between 1998 and 2005. We included in the study those patients that were alive at the moment of first hospital discharge (72%; n=40 patients). ECMO therapy was needed in 6 of them during neonatal treatment. A descriptive transverse review of the clinical record as well as a telephonic interview to the parents was performed for the respiratory, cardiological, digestive and neurological conditions, following standard diagnostic studies in every case. The mean age of the children in the moment of the study was 4.2 years (1-9). RESULTS: The 8.3% of the children needed domiciliary oxygen therapy during a maximum of 3 months in all the cases. 22% of the cases suffered from respiratory problems, being bronchiolitis and pneumonia the most frequent diagnoses. Only a patient developed asthma. The gastroesophageal reflux is the most frequent long-term condition (47%), but only 8.3% needs surgical treatment. Regarding to cardiological problems, 14% developed pulmonary hypertension, being slight - moderate in all the cases but in one case who was the only deceased of the series. Regarding to neurological problems only 1 patient developed serious alterations (brain paralysis), having suffered a hemorrhage parenquimatosa during the treatment with ECMO. No other patient presents motor, visual nor auditory alterations in the development, last mild alteration in language (4 patients). Differences do not exist with the group of patients that did not need ECMO during the treatment in cardiological and digestive complications, being higher percentage with respiratory problems. CONCLUSION: In our sample only 2 patients present serious sequels (5%). Of this preliminary study we can conclude that the comorbility in the CDH is very low having these patient a good development and good quality of life.

[Two different intra-corneal inlay surgical technique in rabbit eyes]. / Comparación de dos técnicas de implantación de lentes intracorneales en ojos de conejo.

OBJECTIVE: To compare two different surgical techniques of intracorneal lens implantation. To determine the incidence of corneal and lens complications in two groups of rabbits subjected to such surgery. METHOD: The first group (7 rabbits) initially had a keratectomy performed with the microkeratome following which the corneal flap was sutured to the stromal layer. In the second group (7 rabbits), a pocket-shaped stromal dissection was performed manually. Both groups of rabbits had a secondary lens implantation in the corneal inlay. The follow up period was of 2 months duration. RESULTS: The incidence of corneal edema in the first month was higher in group 1 (71.4%) than in group 2 (14.3%) (p = 0.0155); during the second month, the incidence was 42.9% in group 1 and 28.6% in group 2 (p= 0.2927). Flap dislocation and retraction of the flap was seen in 4 of the 7 rabbits in group 1, whereas no complication of this type was observed in the manual pocket group (group 2). The incidence of lens subluxation was 28.6% in group 1 and 0% in group 2. Finally, there was a 71.4% (5/7) loss of the intracorneal lens in the rabbits treated with the microkeratome (group 1) while only 1 of 7 rabbits (14.3%) lost the lens in group 2 (P = 0.0155). DISCUSSION: Eyes in which the corneal pocket shape was made by manual stromal dissection had a higher stability of the lens and less post-operative corneal complications.

Comparación de dos técnicas de implantación de lentes intracorneales en ojos de conejo / Two different intra-corneal inlay surgical technique in rabbit eyes

Objetivos: Comparación de dos técnicas quirúrgicas para la implantación de lentes intracorneales. Incidencia de complicaciones corneales y lenticulares en 2 grupos de conejos intervenidos con las técnicas descritas.Método: Estudio experimental en 2 grupos de conejos. Grupo 1 (siete conejos): se practica una queratectomía con microqueratomo, se implanta la lente y se sutura la córnea con dos puntos. Grupo 2 (siete conejos): se talla un bolsillo estromal según técnica manual, se implanta la lente y se sutura la zona de la incisión con 2 puntos. En ambos grupos se realizó un seguimiento por 2 meses.Resultados: La incidencia de edemas corneales en el primer mes fue superior (71,43%) en el grupo 1 y menor en el 2 (14,28%) (p: 0,0155), así como en el segundo mes (42,86% vs 28,57%) (p: 0,2927). Se observaron adhesiones incompletas y retracciones de la queratectomía (4/7) en el grupo 1, complicaciones no observadas en el grupo 2. La incidencia de descentramientos de la lente fue del 28,57% en el grupo 1 y del 0% en el grupo 2. La pérdida de lente intracorneal se produjo en cinco de los siete casos (71,43%) del grupo 1 y en solo 1 de 7 (14,28%) del grupo 2 (P: 0,0155).Conclusiones: Los ojos intervenidos por medio de la técnica manual denominada de bolsillo, fueron los que presentaron más seguridad en cuanto a estabilidad de la lente intracorneal (descentramientos y pérdida de lentículo) y menor incidencia de complicaciones postoperatorias corneales

Objective: To compare two different surgical techniques of intracorneal lens implantation. To determine the incidence of corneal and lens complications in two groups of rabbits subjected to such surgery. Method: The first group (7 rabbits) initially had a keratectomy performed with the microkeratome following which the corneal flap was sutured to the stromal layer. In the second group (7 rabbits), a pocket-shaped stromal dissection was performed manually. Both groups of rabbits had a secondary lens implantation in the corneal inlay. The follow up period was of 2 months duration. Results: The incidence of corneal edema in the first month was higher in group 1 (71.4%) than in group 2 (14.3%) (p= 0.0155); during the second month, the incidence was 42.9% in group 1 and 28.6% in group 2 (p= 0.2927). Flap dislocation and retraction of the flap was seen in 4 of the 7 rabbits in group 1, whereas no complication of this type was observed in the manual pocket group (group 2). The incidence of lens subluxation was 28.6% in group 1 and 0% in group 2. Finally, there was a 71.4% (5/7) loss of the intracorneal lens in the rabbits treated with the microkeratome (group 1) while only 1 of 7 rabbits (14.3%) lost the lens in group 2 (P= 0.0155). Discussion: Eyes in which the corneal pocket shape was made by manual stromal dissection had a higher stability of the lens and less post-operative corneal complications

Efecto hipotensor de la pilocarpina en ojos tratados crónicamente con latanoprost; un estudio piloto / Ocular hypotensive effect of pilocarpine in latanoprost treated eyes; a pilot study

Objetivo: Estudiar el efecto hipotensor de la pilocarpina en ojos tratados crónicamente con latanoprost.Métodos: Se midió la PIO de ambos ojos de 25 pacientes antes y después de administrar pilocarpina al 2 por ciento en un ojo, y placebo en el ojo contralateral. Éste es un estudio prospectivo, doble ciego y controlado con placebo.Resultados: Nosotros encontramos que la pilocarpina produjo un cambio tensional en los ojos estudio de +0,4 mmHg en promedio, (rango -3 a +5 mmHg) con respecto a los ojos control, tratados con placebo (p=0,5).Conclusiones: La administración de pilocarpina a ojos tratados crónicamente con latanoprost parece tener un efecto paradójico en la PIO, que puede aumentar o disminuir (AU)

[Ocular hypotensive effect of pilocarpine in latanoprost treated eyes; a pilot study]. / Efecto hipotensor de la pilocarpina en ojos tratados crónicamente con latanoprost; un estudio piloto.

PURPOSE: To study the ocular hypotensive effect of pilocarpine in latanoprost treated eyes. METHODS: We measured the IOP in both eyes of 25 patients, before and after instillation of pilocarpine 2% in one eye, and placebo in the other. This is a prospective, double blind, placebo-controlled study. RESULTS: We found that the mean change in IOP of the study eyes was +0.4 on average (range of change from -3 to +5 mmHg), compared with the control, placebo treated eyes (p=0.5). CONCLUSIONS: The acute administration of pilocarpine in Latanoprost treated eyes seems to have a paradoxical effect on IOP, as the IOP may increase or decrease.