Análisis de factores de riesgo de gravedad de la coqueluche en un hospital pediátrico / Analysis of risk factors for severe pertussis in a pediatric hospital

A pesar de la implementación de la vacuna antipertussis en el Calendario Nacional continúan ocurriendo casos graves de coqueluche en Argentina. Objetivo: Identificar factores de riesgo de gravedad al ingreso hospitalario (definida como requerimientos de internación en Unidad de Cuidados Intensivos o fallecimiento). Métodos: Estudio de casos y controles: 32 casos de coqueluche vs. 89 casos no graves (enero el diciembre de 2004 y 2007). Todos los casos y controles fueron confirmados por PCR en SNF. Análisis estadístico (STATA 8.0). Resultados: 121 pacientes fueron incluidos (edad mediana 2 meses). Se observó contacto con adulto tosedor 35 por ciento vacunación en el 54 por ciento (1 dosis en 71 por ciento, 2 dosis en 21 por ciento, 3 dosis en 6 por ciento, 4 dosis en el 2 por ciento). Quince niños de los 32 que requirieron UCI fallecieron. Los motivos de admisión a UCI fueron falla respiratoria severa en 15 pacientes (47 por ciento) y asociada a falla hemodinámica in 17 p. (53 por ciento). Análisis multivariado la leucocitosis mayor a 50 por 10 3 (OR 4.46 IC 95 por ciento 1.66- 11.99) y la apnea (OR 4IC95 por ciento 1.53 - 10.91), al ingreso hospitalario fueron predictores de mal pronóstico. Conclusiones: Los niños pequeños sin edad suficiente para recibir la vacuna tienen riesgo de presentar formas graves. La leucocitosis y la apnea fueron predictores de mal pronóstico. Los pacientes con riesgo de enfermedad severa grave deben tener acceso a centros de alta complejidad. Se debe mantener alta sospecha disgnóstica y cobertura de vacunación adecuada.

[Diffuse cervical cellulites and descending necrotizing mediastinitis]. / Cellulites cervicales extensives et médiastinite descendante nécrosante.

OBJECTIVES: To give a report on the progress in physical examination, investigations and treatment of diffuse cervical cellulites (DCC) associated with descending necrotizing mediastinitis. MATERIALS AND METHODS: A Retrospective study (1995-2005) of patients presenting DCC with mediastinitis was made. All had a cervical and thoracic Computed tomography (CT) scan. The references were collected by a Medline search. RESULTS: Six men and 2 women, average ages 53 years were treated. Four had an immunodeficient status. Two had had an anti-inflammatory drug treatment without antibiotic treatment. The average for diagnosis and treatment was 4 days. In 2 cases we found a dental origin and in 6 cases a pharyngeal origin. The most frequently identified germs were streptococcus beta haemolytic group A and Prevotella. In 4 cases, no physical sign of mediastinitis was noted. The diagnosis of mediastinitis was made thanks to the thoracic CT scan. All the patients were treated by broad-spectrum antibiotic therapy. All had cervical and thoracic surgical drainage. Mediastinal drainage was made by cervical way in 3 cases and by thoracotomy in 5 cases. One patient died. CONCLUSIONS: The DCC with mediastinum extension are serious infectious emergencies with a high mortality rate. Clinical diagnosis of mediastinitis is difficult. A thoracic CT scan should be performed systematically. Performing thoracotomy best controls mediastinal drainage.

[Schwannomas of the neck. About 3 cases, and literature review]. / Schwannomes du cou. A propos de 3 cas, revue de la littérature.

INTRODUCTION: Schwannomas of the neck are rare. Their diagnosis remains difficult despite the evolution of imaging techniques. The goals of our study were to review the diagnostic and therapeutic approach for these tumors. MATERIALS AND METHODS: Retrospective study (1998-2005) concerning 3 cases of schwannoma in rare localizations: superior laryngeal nerve, ansa cervicalis and deep cervical plexus. These 3 patients were operated on in our ENT head and neck department. We made a review of the literature using the Medline database. RESULTS: The mean delay between symptomatology and treatment was 5 years. In all cases, the schwannoma presented with a slowly-growing cervical mass. In only one case, the diagnosis of schwannoma was maded preoperatively. All 3 patients were treated surgically and the involved nerve was sacrificied. There were no postoperative complications. The mean follow-up duration was 3.5 years, with no recurrence. DISCUSSION-CONCLUSION: To establish a diagnosis of neck schwannoma, ultrasound is the least sensitive imaging tool. Fine needle aspiration is especially useful to rule out other conditions. The most relevant diagnostic tools are CT-scan and especially MRI. Treatment is surgical; it should include sacrifice of the involved nerve. Surgical exploration of the neck and tumor resection could be performed at the same operation in the informed patient aware of the sequelae of nerve sacrifice, or otherwise be performed in two steps in the uninformed patient.

Oromandibular reconstruction using titanium plate and pectoralis major myocutaneous flap.

To assess whether locking-screw titanium plates (UniLOCK) and pedicled pectoralis major myocutaneous flaps are a valid alternative to complex reconstruction with bony free flaps in poor prognosis or poor performance status oncological patients with mandibular defects, a retrospective evaluation has been made of outcomes in 27 consecutive cases. No patient died perioperatively. Mean operating time was 270 minutes. Post-operative course was uneventful in 14. Mean follow-up was 13 months with no loss to follow-up. Twelve patients are alive and well, 12 died from their malignancy, two from non-neoplastic causes, and one from second cancer. Plate exposure - the main problem with bridging plates - occurred in 6 (22%, 4 early, 2 late), 4 with symphyseal and 2 with postero-lateral defects: removal was necessary in 2; 2 died with the plate exposed, and 2 had successful re-coverage, increasing the final success rate from 78% to 85%. Most patients considered the aesthetic outcome acceptable, however all edentulous patients complained of unsatisfactory dental rehabilitation. From the acceptable success rate, it may be concluded that bridging plates represent a useful reconstruction method, provided they are well covered by viable muscular tissue. They should be offered to patients contraindicated for more invasive procedures or with limited functional needs, or poor prognosis.