Un raro traumatismo obstétrico: fractura desplazada de metáfisis femoral en un recién nacido sano / A rare obstetrical injury: displaced fracture of femoral metaphysis at birth in an otherwise healthy infant

Se presenta el caso de un niño varón, nacido a término por cesárea en presentación podálica, tras el parto, sin realización de maniobras obstétricas agresivas, presentó una fractura oblicua y desplazada de la metáfisis femoral. En este artículo se anliza tanto la forma atípica de presentación clínica como de localización, y se evalúa la respuesta al tratamiento y las posibles secuelas durante el primer año de vida

In this article, we report the case of a male infant who was delivered by cesarean section due to breech presentation. After the delivery, which had not involved the performance of aggressive obstetrical maneuvers, it was discovered that he had sustained a displaced fracture of the femoral metaphysis. In this article, the authors analyze both the atypical clinical presentation and fracture site, as well as the response to treatment and sequelae throughout his first year of life

Análisis epidemiológico georreferencial de la mortalidad infantil en la Ciudad Autónoma de Bs.As. en un período de doce años (19909-2002) / Georeferential epidemiological analysis of the infant mortality rate in Buenos Aires City during a 12-year period (1990-2002)

The objective of this investigation was to determine a georeferential epidemiological analysis of the infant mortality rate in the city of Buenos Aires during a 12 year period (1990-2002). Several facts are evident from this review of the causes of that infant mortality. The overall mortality rate of infants in this city was 9.1 per 1,000, for the 12-years period between 1990 and 2002

Análisis epidemiológico georreferencial de la mortalidad infantil en la Ciudad Autónoma de Bs.As. en un período de doce años (19909-2002) / Georeferential epidemiological analysis of the infant mortality rate in Buenos Aires City during a 12-year period (1990-2002)

The objective of this investigation was to determine a georeferential epidemiological analysis of the infant mortality rate in the city of Buenos Aires during a 12 year period (1990-2002). Several facts are evident from this review of the causes of that infant mortality. The overall mortality rate of infants in this city was 9.1 per 1,000, for the 12-years period between 1990 and 2002

Etica y Salud Pública / Ethics and Public Health

This article describes the concepts of ethics and public health, with special reference to conceptual designs and operative tools

Etica y Salud Pública / Ethics and Public Health

This article describes the concepts of ethics and public health, with special reference to conceptual designs and operative tools

[Hemolytic anemia disclosing Wilson's disease. Report of 2 cases]. / Anémie hémolytique révélatrice d'une maladie de Wilson. A propos de deux observations.

INTRODUCTION: The liver and central nervous system are the usual targets of Wilson's disease, an inherited disorder of copper metabolism. Severe hemolytic anemia is an unusual complication of Wilson's disease. EXEGESIS: We report two cases of Wilson's disease revealed by acute intravascular hemolytic anemia associated with liver failure. Blood smear analysis showed stippled red cells in one case; hemolytic anemia improved within a few weeks in both patients but progressive liver failure required transplantation in the other. Hemolysis probably results from the toxic effect of free serum copper on erythrocyte membrane. CONCLUSION: Diagnosis of Wilson's disease must be considered in case of acute hemolytic anemia associated with liver failure in young adults.

Peroperative titration of morphine improves immediate postoperative analgesia after total hip arthroplasty.

PURPOSE: To determine the Influence of peroperative titrated morphine on postoperative pain control. METHODS: Forty patients received general anesthesia for total hip arthroplasty (THA) and were divided into two groups of 20. In the Peroperative group (Perop group;) morphine was titrated at the end of surgery (3 mg i.v. every 5 or 10 min) in spontaneously breathing intubated patients, until the respiratory rate (RR) decreased. No morphine was administered to Postop group. In the Post Anesthesia Care Unit (PACU) patients in Perop and Postop groups received morphine until adequate pain relief VAS < or = 30 mm. Patients used patient-controlled analgesia (PCA) for the next 24 hr. In the PACU, the delay for analgesia, doses of morphine used and incidence of side effects were recorded. RESULTS: In the Perop group, patients received 10.3 +/- 1.3 mg (2-20 mg) as peroperative titration and had achieved adequate analgesia more rapidly than in the Postop group (42 +/- 7 min vs 76 +/- 7 min); P = 0.0026). Analgesia in the PACU in the Postop group required larger doses of morphine (15.4 +/- 1.5 mg;) than in the Perop group (7.3 +/- 1.3 mg; P = 0.0004). The respiratory rate decrease during peroperative morphine titration was correlated to the morphine dose needed in the PACU (P = 0.035). Respiratory depression in the PACU was more common in the Postop group than in the Perop group (five patients vs no patient P = 0.017). CONCLUSION: This study demonstrated that the peroperative administration of morphine can facilitate immediate postoperative pain management.

Economic aspects of a general vaccination against invasive disease caused by Haemophilus influenzae type b (Hib) via the experience of the Children's Hospital La Fe, Valencia, Spain.

With the aim of studying whether a general vaccination against invasive disease caused by Haemophilus influenzae type b (Hib) is economically profitable bearing in mind the efficacy and safety of the vaccine, its price and the global cost that this disease has in our area, a review is conducted of patients admitted due to invasive disease caused by Hib in the Children's Hospital La Fe, Valencia, born between 1984 and 1993. They total 100, 63 who have meningitis. In the 81 cases (56 with meningitis) born between 1984 and 1990 (years that can be regarded as "closed" since all the patients were younger than 5 years of age) the total cost has been calculated for hospitalization, care during the acute phase, care for the sequelae (6 severe and 7 mild) and death (5 cases). The mean annual cost of care can be calculated at 62 million pesetas, without making an economic valuation of the loss of life, and at 205 million pesetas taking this factor into account. The annual cost of vaccinating the 7000 babies under one year of age and falling within the Hospital's catchment area, on the basis of a vaccination pattern of three doses (at 2, 4 and 6 months) or four doses (at 2, 4, 6 and 15 months) would amount to 63 or 84 million pesetas, normal price to public (not covered by National Health Service), and 40 or 51 million pesetas if acquired by National Health Service. As a conclusion we can state that, even from the economic point of view, without quantifying the cost of the loss of life, a public general anti-Hib vaccination would be profitable in our area since it would mean an administration cost lower than that of the care required by patients. This is without taking into account the fact that emotional, family and social serious disturbances would also be avoided due to hospitalization, sequelae and deaths caused by a disease which is today perfectly preventable.

Estudio multicéntrico comparativo sobre tolerancia y eficacia de terfenadina vs. placebo en urticaria crónica / Comparative multicenter study on the tolerance and efficacy of terfenadine vs. placebo in chronic urticaria

La terfenadina es un nuevo bloqueador específico de los receptores H1 periféricos. Diversos estudios clínicos realizados en los Estados Unidos y Europa han demostrado su eficacia en el tratamiento de la urticaria y la rinitis alérgica, así como la ausencia de efecto sedante, incluso cuando se administra conjuntamente con tranquilizantes o alcohol. El objetivo de nuestro estudio fue una evaluación comparativa de la tolerancia y eficacia de terfenadina y placebo, en el tratamiento de urticaria crónica, en pacientes latinoamericanos